冠状动脉旁路移植术动脉移植物旋股外动脉降支与乳内动脉血管功能的比较
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江苏省卫生健康委医学科研项目(ZDA2020004)


Comparison of the vascular function of the descending branch of the external circumflex femoral artery and the internal mammary artery in coronary artery bypass grafting
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    摘要:

    目的:比较冠状动脉旁路移植术动脉移植物旋股外动脉降支(descending branch of lateral circumflex femoral artery,DBLCFA)与乳内动脉(internal mammary artery,IMA)的血管功能,根据二者对血管收缩剂和舒张剂的药理学反应评估其痉挛特征及内皮功能。方法:将20例冠状动脉搭桥患者的33支DBLCFA血管环和31支IMA血管环平衡于器官浴中。血管收缩性由受体介导的血管收缩剂内皮素-1、 血管紧张素Ⅱ和血栓素A2模拟物U46619检测。乙酰胆碱用于测试内皮依赖性舒张,硝酸甘油用于测试非内皮依赖性舒张。比较两种动脉的最大收缩或舒张反应,以及引起50 %最大收缩或舒张反应的有效浓度。结果:内皮素-1、血管紧张素Ⅱ和U46619引起的收缩中,DBLCFA的反应性均高于乳内动脉,分别为[(0.94±0.09)g vs.(0.57±0.08)g,P=0.012]、[(0.88±0.13)g vs.(0.24±0.05)g,P < 0.001]、[(4.95±0.57)g vs.(1.86±0.30)g,P=0.001]。转换成由100 mmol/L KCl引起的收缩力百分比时,两者无明显差异。由内皮素-1和血管紧张素Ⅱ引起的50 %最大收缩反应的有效浓度无明显差异。由U46619引起的50 %最大收缩反应有效浓度,DBLCFA高于IMA。受体介导的内皮依赖性舒张和非内皮依赖性舒张在两种血管间无明显差异。两种动脉引起50 %最大舒张反应的有效浓度无明显差异。结论:DBLCFA对血管收缩剂的药理学反应高于IMA,提示其更易发生血管痉挛。DBLCFA舒张反应与IMA相似,但DBLCFA更易痉挛,因而其血管功能次于IMA。但当IMA使用受限时,DBLCFA可作为一种选择。

    Abstract:

    Objective:This study aims to compare the vascular function of the descending branch of lateral circumflex femoral artery(DBLCFA)and the internal mammary artery(IMA)of coronary artery bypass grafts,according to the vasoconstrictor and diastolic effects of the two drug pharmacological response to evaluate its spasticity characteristics and endothelial function. Methods:The 33 descending branches of the external circumflex femoral artery and 31 internal mammary arteries of 20 patients with coronary artery bypass grafting were balanced in the organ bath. Vasoconstriction was detected by receptor-mediated vasoconstrictors endothelin-1,angiotensin Ⅱ and thromboxane A2 mimic U46619. Acetylcholine was used to test endothelium-dependent relaxation,and nitroglycerin was used to test endothelium-independent relaxation. The maximum contraction or relaxation response of the two arteries,and the effective concentration that caused 50% of the maximum contraction or relaxation response were compared. Results:In the contraction caused by endothelin-1,angiotensin Ⅱ and U46619,the reactivity of DBLCFA was higher than that of IMA,respectively[(0.94±0.09)g vs.(0.57±0.08)g,P=0.012;(0.88±0.13)g vs.(0.24±0.05)g,P < 0.001;(4.95±0.57)g vs.(1.86±0.30)g,P=0.001]. When converted into the percentage of contractile force caused by 100 mmol/L KCl,there was no significant difference between the two groups. There was no significant difference in the effective concentration of 50% of the maximum contractile response caused by endothelin-1 and angiotensin Ⅱ. The effective concentration of 50% of the maximum contractile response caused by U46619 of DBLCFA was higher than that of IMA. There were no significant differences between receptor-mediated endothelium-dependent relaxation and non-endothelium-dependent relaxation between the two types of blood vessels. There were no significant differences in the effective concentration of 50% of the maximum diastolic response between the two arteries. Conclusion:DBLCFA has a higher pharmacological response to vasoconstrictors than the IMA,suggesting that it is more prone to vasospasm. The diastolic response of DBLCFA is similar to that of IMA,but DBLCFA is more prone to spasm. So its vascular function is inferior to that of the IMA. But when the use of IMA is limited,DBLCFA may be an option for the surgeon.

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沈晓炜,李 奔,季宇萌,王旭枫,徐骁晗,陆小虎,王晓伟.冠状动脉旁路移植术动脉移植物旋股外动脉降支与乳内动脉血管功能的比较[J].南京医科大学学报(自然科学版),2021,(11):1626-1631

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  • 收稿日期:2021-07-13
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  • 在线发布日期: 2021-12-13
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