Piamsomboon C, Tanaka K A, Szlam F, Makita T, Huraux C, Levy J H
Department of Anesthesiology, Emory University School of Medicine, Division of Cardiothoracic Anesthesia and Critical Care, The Emory Clinic, Atlanta, GA 30322, USA.
Acta Anaesthesiol Scand. 2007 Jul;51(6):714-21. doi: 10.1111/j.1399-6576.2007.01328.x. Epub 2007 May 4.
Peri-operative pulmonary hypertension can lead to right ventricular dysfunction and to an increase in morbidity and mortality. Altered function of the pulmonary vascular endothelium and vasoconstriction play a crucial role in the development of elevated pulmonary vascular resistance. Because pulmonary artery vasoreactivity is dependent on many factors including the constricting agent that precipitated the event therefore the aim of the current study was to investigate the effectiveness of different classes of vasodilator agents to reverse endothelin-1 (ET-1) or thromboxane A(2) (TxA(2))-induced vasoconstriction in porcine pulmonary artery (PA) in vitro.
Relaxation responses to vasodilatory drugs were studied in PA precontracted with ET-1 (1 x 10(-8) M) or TxA(2) analog (U46619, 1 x 10(-8) M). All vasodilating drugs were added in a cumulative fashion and isometric tension measurements were obtained using an organ chamber technique.
In both groups relaxation responses to the vasodilators were dose dependent. When ET-1 was used as a constrictor nitroglycerin and milrinone caused nearly complete (80-100%) relaxation, whereas other agents were of limited effectiveness (40-50%). On the other hand, in the vessels constricted with U46619, olprinone, indomethacin, prostaglandin E(1) (PGE(1)), nitroglycerin, milrinone and clevidipine induced complete (90-110%) vasodilatation but brain natriuretic peptide (BNP), L-arginine, and isoproterenol relaxed the vessels maximally by 45-60%.
Nitroglycerin and milrinone are very effective in reversing ET-1 and U46619-induced pulmonary vasoconstriction in vitro. The effectiveness of other drugs studied was dependent on the type of constrictor used. BNP, L-arginine and isoproterenol were shown to have minimal vasodilatory effects in porcine PA.
围手术期肺动脉高压可导致右心室功能障碍,并增加发病率和死亡率。肺血管内皮功能改变和血管收缩在肺血管阻力升高的发展中起关键作用。由于肺动脉血管反应性取决于许多因素,包括引发该事件的收缩剂,因此本研究的目的是在体外研究不同类别的血管扩张剂逆转内皮素-1(ET-1)或血栓素A2(TxA2)诱导的猪肺动脉(PA)血管收缩的有效性。
在预先用ET-1(1×10⁻⁸M)或TxA2类似物(U46619,1×10⁻⁸M)预收缩的PA中研究对血管扩张药物的舒张反应。所有血管扩张药物以累积方式添加,并使用器官浴槽技术获得等长张力测量值。
在两组中,对血管扩张剂的舒张反应均呈剂量依赖性。当使用ET-1作为收缩剂时,硝酸甘油和米力农引起几乎完全(80-100%)的舒张,而其他药物效果有限(40-50%)。另一方面,在用U46619收缩的血管中,奥普力农、吲哚美辛、前列腺素E1(PGE1)、硝酸甘油、米力农和 clevidipine 诱导完全(90-110%)血管舒张,但脑钠肽(BNP)、L-精氨酸和异丙肾上腺素使血管最大舒张45-60%。
硝酸甘油和米力农在体外非常有效地逆转ET-1和U46619诱导的肺血管收缩。所研究的其他药物的有效性取决于所用收缩剂的类型。BNP、L-精氨酸和异丙肾上腺素在猪肺动脉中显示出最小的血管舒张作用。