Chong W C, Ong P J, Hayward C, Moat N, Collins P
Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
J Thorac Cardiovasc Surg. 2001 Sep;122(3):470-5. doi: 10.1067/mtc.2001.115921.
Surgical preparation of coronary conduits for coronary artery bypass grafting may affect their early and long-term patency; one mechanism may involve endothelial damage. We investigated the effect of 3 commonly used solutions-Ringer's solution, normal saline solution, and heparinized whole blood-on in vitro endothelial and contractile functions of the human radial artery.
Radial artery segments were harvested, cut into 3-mm rings, and stored in unoxygenated Ringer's solution, normal saline solution, or heparinized whole blood for 45 minutes. Rings stored in Krebs solution were used as controls. The rings were then mounted and stretched to an optimal resting tension in oxygenated Krebs solution at 37 degrees C. Contraction responses to potassium, norepinephrine, and serotonin and relaxation responses to acetylcholine, verapamil, and nitroprusside were evaluated.
Fifty-six radial artery ring segments from 14 patients (n = 7 rings for each contraction-relaxation curve) were studied. Equilibrated resting tension was 9.6 +/- 0.3 mN (5.9 +/- 0.2 g), and resting internal circumference was 6.4 +/- 0.2 mm. Absolute maximum contraction to potassium was significantly less in rings stored in normal saline solution than in rings stored in control solution (10.7 +/- 0.6 g vs 14.5 +/- 0.6 g, P <.01; 95% confidence intervals, 0.9-6.9). There was no difference in the contraction to norepinephrine (P =.11) and serotonin (P =.25) among the 3 solutions compared with the control solution. Rings stored in heparinized whole blood had significantly greater endothelium-dependent relaxation to acetylcholine (P <.007), whereas those stored in normal saline solution had reduced responses. Endothelium-independent relaxation to verapamil and nitroprusside were similar among the 3 solutions.
Heparinized whole blood is a better physiologic medium for preservation of radial artery endothelial and contractile functions during storage before grafting.
冠状动脉搭桥术中冠状动脉血管桥的外科处理可能会影响其早期和长期通畅性；一种机制可能涉及内皮损伤。我们研究了3种常用溶液（林格液、生理盐水和肝素化全血）对人桡动脉体外内皮功能和收缩功能的影响。
获取桡动脉节段，切成3毫米的环，置于无氧的林格液、生理盐水或肝素化全血中保存45分钟。保存在克雷布斯溶液中的环用作对照。然后将环安装并在37℃的含氧克雷布斯溶液中拉伸至最佳静息张力。评估对钾、去甲肾上腺素和5-羟色胺的收缩反应以及对乙酰胆碱、维拉帕米和硝普钠的舒张反应。
研究了来自14例患者的56个桡动脉环节段（每条收缩-舒张曲线n = 7个环）。平衡后的静息张力为9.6±0.3 mN（5.9±0.2 g），静息内径为6.4±0.2 mm。与保存在对照溶液中的环相比，保存在生理盐水中的环对钾的绝对最大收缩明显较小（10.7±0.6 g对14.5±0.6 g，P <.01；95%置信区间，0.9 - 6.9）。与对照溶液相比，3种溶液对去甲肾上腺素（P =.11）和5-羟色胺（P =.25）的收缩反应无差异。保存在肝素化全血中的环对乙酰胆碱的内皮依赖性舒张明显更大（P <.007），而保存在生理盐水中的环反应减弱。3种溶液对维拉帕米和硝普钠的非内皮依赖性舒张相似。
肝素化全血是在移植前保存桡动脉内皮和收缩功能的更好的生理介质。
