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
Journal of Nanjing Medicial University（2021）
Abstract
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.
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