Smith F C, Tsang G M, Watson H R, Shearman C P
University Department of Vascular Surgery, Queen Elizabeth Hospital, Edgbaston, Birmingham, U.K.
Eur J Vasc Surg. 1992 Mar;6(2):194-8. doi: 10.1016/s0950-821x(05)80240-3.
A randomised placebo-controlled trial was conducted to investigate the effect of iloprost, a stable prostacyclin mimetic, on peripheral resistance during femoro-distal bypass. Patients undergoing femoro-distal long saphenous vein bypass for critical ischaemia received 3000 ng of iloprost or placebo infused into the graft via an unligated side branch over 2 min. Graft blood flow and peripheral resistance were measured for 20 min, using an operative Doppler flowmeter (OpDop 130, SciMed, U.K.) and a pressure transducer to record graft pressure. Postoperatively, graft blood flow was assessed by daily duplex ultrasound for 7 days. Iloprost produced an immediate drop in peripheral resistance in all cases (n = 18) by a mean (range) of 40% (4-80%) compared with controls (n = 15) in whom there was a 5.3% (-8 to +36%) increase in resistance (p less than 0.01, Wilcoxon test). Decreased peripheral resistance in iloprost-treated patients persisted to 20 min. The largest decreases in peripheral resistance occurred in patients with the highest initial resistances (r = 0.56, p less than 0.02). Graft flow during the same period increased by 52% (-7 to 294%) compared with controls in whom there was a 6% (-17 to 26%) increase in flow, (p less than 0.01). Flow remained elevated by 53% over baseline values at 1 week post-infusion in the iloprost-treated group but this did not achieve statistical significance compared to controls in whom flow also increased by 13%. Iloprost produces an immediate decrease in peripheral resistance associated with a prolonged increase in graft blood flow. This may reduce graft failure in the early postoperative period.
进行了一项随机安慰剂对照试验，以研究伊洛前列素（一种稳定的前列环素类似物）对股-远端旁路手术期间外周阻力的影响。因严重缺血接受股-远端大隐静脉旁路手术的患者，通过未结扎的侧支在2分钟内将3000纳克伊洛前列素或安慰剂注入移植物。使用手术用多普勒流量计（OpDop 130，SciMed，英国）和压力传感器记录移植物压力，测量移植物血流和外周阻力20分钟。术后，通过每日双功超声评估移植物血流，持续7天。与对照组（n = 15）相比，伊洛前列素在所有病例（n = 18）中使外周阻力立即下降，平均（范围）为40%（4%-80%），而对照组阻力增加了5.3%（-8%至+36%）（Wilcoxon检验，p小于0.01）。伊洛前列素治疗的患者外周阻力降低持续至20分钟。外周阻力下降最大的发生在初始阻力最高的患者中（r = 0.56，p小于0.02）。同期，与对照组相比，移植物血流增加了52%（-7%至294%），而对照组血流增加了6%（-17%至26%）（p小于0.01）。在伊洛前列素治疗组中，输注后1周时血流仍比基线值升高53%，但与对照组相比未达到统计学显著性，对照组血流也增加了13%。伊洛前列素可使外周阻力立即降低，并伴有移植物血流的持续增加。这可能会降低术后早期移植物失败的发生率。
