局部血管扩张剂对胃网膜动脉移植物的影响。

Effect of topical vasodilators on gastroepiploic artery graft.

作者信息

Chavanon O, Cracowski J L, Hacini R, Stanke F, Durand M, Noirclerc M, Blin D

机构信息

Department of Cardiac Surgery, Grenoble University Hospital, France.

出版信息

Ann Thorac Surg. 1999 May;67(5):1295-8. doi: 10.1016/s0003-4975(99)00222-2.

DOI:10.1016/s0003-4975(99)00222-2

PMID:10355400

Abstract

BACKGROUND

Mobilization of the gastroepiploic artery (GEA) often results in a vasospasm with reduction of early graft flow. In order to prevent or suppress this highly reactive artery's spasm, we have compared the effect of 4 vasodilators, used in external application to prepare the GEA graft, prior to myocardial revascularization.

METHODS

WE performed a double-blind clinical study to compare the effects of external application of vasodilators on gastroepiploic artery grafts. Fifty patients, whose gastroepiploic artery was used for coronary artery bypass grafting, were randomized into 5 groups of 10 patients. Gastroepiploic artery free flow and hemodynamic measurements were evaluated immediately after harvesting, before any pharmacological manipulation, and 10 minutes after the topical application of vasodilators, respectively: papaverine, linsidomine, nicardipine, glyceryl trinitrate, and normal saline solution.

RESULTS

A significant increase in free flow occurred in all groups except for the normal saline solution group with measurements from 26.1+/-3.6 mL/min to 26.4+/-6.5 mL/min; p = 0.9. The most important increase in flow before and after local application occurred with glyceryl trinitrate and papaverine: from 25.5+/-2 mL/min to 50+/-6.1 mL/min (p < or = 0.01) and from 36.8+/-3.2 mL/min to 62+/-7.8 mL/min (p < 0.01) respectively. Nicardipine and linsidomine produced a less significant increase in flow: from 33.1+/-3.6 mL/min to 47.7+/-8.9 mL/min (p < 0.05) and from 28+/-3.8 mL/min to 39.8+/-7.5 mL/min (p < 0.05) respectively. When comparing percentage of flow increase, glyceryl trinitrate appeared to be significantly more efficient than nicardipine and linsidomine (p < 0.01 versus both groups). Although papaverine was more efficient than nicardipine and linsidomine, it did not reach statistical significance.

CONCLUSIONS

During intraoperative preparation of the GEA graft, glyceryl trinitrate and papaverine to a lesser extent, used as topical vasodilators, appear to be more efficient in external application to increase the free flow of the GEA.

摘要

背景

胃网膜动脉（GEA）的游离操作常导致血管痉挛，使早期移植物血流减少。为预防或抑制这条高反应性动脉的痉挛，我们比较了4种血管扩张剂在心肌血运重建术前外用制备GEA移植物时的效果。

方法

我们进行了一项双盲临床研究，比较血管扩张剂外用对胃网膜动脉移植物的影响。50例使用胃网膜动脉进行冠状动脉旁路移植术的患者被随机分为5组，每组10例。分别在获取胃网膜动脉后、进行任何药物处理前以及外用血管扩张剂10分钟后，评估胃网膜动脉的自由血流和血流动力学指标：罂粟碱、亚硝基铁氰化钠、尼卡地平、硝酸甘油和生理盐水。

结果

除生理盐水组外，所有组的自由血流均显著增加，测量值从26.1±3.6 mL/分钟增至26.4±6.5 mL/分钟；p = 0.9。局部应用前后血流增加最为显著的是硝酸甘油和罂粟碱：分别从25.5±2 mL/分钟增至50±6.1 mL/分钟（p≤0.01）和从36.8±3.2 mL/分钟增至62±7.8 mL/分钟（p＜0.01）。尼卡地平和亚硝基铁氰化钠使血流增加的幅度较小：分别从33.1±3.6 mL/分钟增至47.7±8.9 mL/分钟（p＜0.05）和从28±3.8 mL/分钟增至39.8±7.5 mL/分钟（p＜0.05）。比较血流增加百分比时，硝酸甘油似乎比尼卡地平和亚硝基铁氰化钠显著更有效（与两组相比，p＜0.01）。虽然罂粟碱比尼卡地平和亚硝基铁氰化钠更有效，但未达到统计学意义。