He Guo-Wei, Fan Li, Furnary Anthony, Yang Qin
Nankai University Medical College and TEDA International Cardiovascular Hospital, Tianjin, China.
J Thorac Cardiovasc Surg. 2008 Sep;136(3):673-80, 680.e1-2. doi: 10.1016/j.jtcvs.2007.12.019. Epub 2008 May 19.
Antispastic protocols for arterial grafts are important in arterial grafting for coronary artery bypass grafting surgery. We designed a new nicardipine and nitroglycerin cocktail that is composed of a second-generation dihydropyridine calcium antagonist, nicardipine and nitroglycerin (30 micromol/L), and examined its effect in human internal thoracic and radial arteries.
Human internal thoracic (n = 86) and radial (n = 74) artery segments from 72 patients undergoing coronary artery bypass grafting were studied. Relaxation against 3 classic vasoconstrictors (potassium chloride, thromboxane A(2) mimetic U46619, and alpha-adrenoceptor agonist norepinephrine) and prophylactic effect on contraction against these vasoconstrictors were examined. The effect of the nicardipine and nitroglycerin cocktail on the endothelial function in internal thoracic and radial arteries was studied in response to acetylcholine.
Nicardipine and nitroglycerin induced almost full relaxation (92.2% +/- 4.7% to 97.9% +/- 1.0%, P < .001 in internal thoracic arteries and 95.4% +/- 1.9% to 96.7% +/- 3.3%, P < .001 in radial arteries, n = 6-8) against 3 vasoconstrictors with significant prophylactic effect on contraction (maximal contraction was depressed to 32.5% to 76.4%, P < .05 or P < .001, and EC50s were increased to 5 to 42-fold more, P < .01). After treatment with the nicardipine and nitroglycerin cocktail, the acetylcholine-induced relaxation was unchanged (P > .05).
The use of the nicardipine and nitroglycerin cocktail provides a new antispastic protocol that has rapid onset, full relaxation, and excellent prophylactic effect against all known mechanisms of vasospasm and maximally protects the endothelial and smooth muscle function of the internal thoracic and radial arteries. The cocktail is therefore expected to provide a new method in treating grafts in coronary artery bypass grafting with the best antispastic effect and protection of the graft.
在冠状动脉旁路移植手术的动脉移植中，动脉移植物的抗痉挛方案很重要。我们设计了一种由第二代二氢吡啶类钙拮抗剂尼卡地平与硝酸甘油（30微摩尔/升）组成的新型鸡尾酒合剂，并研究了其对人胸廓内动脉和桡动脉的作用。
对72例行冠状动脉旁路移植手术患者的胸廓内动脉段（n = 86）和桡动脉段（n = 74）进行研究。检测其对3种经典血管收缩剂（氯化钾、血栓素A2模拟物U46619和α - 肾上腺素受体激动剂去甲肾上腺素）的舒张作用以及对这些血管收缩剂收缩作用的预防效果。研究尼卡地平与硝酸甘油合剂对胸廓内动脉和桡动脉内皮功能的影响（以乙酰胆碱为刺激物）。
尼卡地平与硝酸甘油对3种血管收缩剂诱导几乎完全舒张（胸廓内动脉为92.2%±4.7%至97.9%±1.0%，P <.001；桡动脉为95.4%±1.9%至96.7%±3.3%，P <.001；n = 6 - 8），对收缩有显著预防作用（最大收缩力降至32.5%至76.4%，P <.05或P <.001，半数有效浓度增加至5至42倍，P <.01）。用尼卡地平与硝酸甘油合剂处理后，乙酰胆碱诱导的舒张作用无变化（P >.05）。
使用尼卡地平与硝酸甘油合剂提供了一种新的抗痉挛方案，起效迅速、舒张完全，对所有已知血管痉挛机制均有出色的预防效果，并能最大程度保护胸廓内动脉和桡动脉的内皮及平滑肌功能。因此，该合剂有望为冠状动脉旁路移植术中处理移植物提供一种具有最佳抗痉挛效果且能保护移植物的新方法。
