Mantz J, Marty J, Pansard Y, Henzel D, Loiseau A, Pocidalo M, Langlois J, Desmonts J M
Department of Anesthesiology, INSERM U 82, Paris, France.
J Thorac Cardiovasc Surg. 1990 Jan;99(1):75-81.
To evaluate whether the function of beta-adrenergic receptors, essential to the biologic activity of catecholamines, is altered during coronary artery bypass grafting, we measured, in 16 patients undergoing myocardial revascularization, the density and the affinity of lymphocyte beta-adrenergic receptors before anesthesia induction (control) and at the end of cardiopulmonary bypass. Variations in the density and affinity of beta-adrenergic receptors were determined in vitro. Repeated determinations of plasma epinephrine and norepinephrine concentrations were also performed. Overall, no significant modification was observed in mean density and affinity of beta-adrenergic receptors at the end of cardiopulmonary bypass when compared with control values. However, a significant decrease (p less than 0.05) in affinity for isoproterenol was found in the six patients who had high catecholamine levels during cardiopulmonary bypass. In contrast, no significant modification of beta-adrenoreceptor affinity for isoproterenol was observed in the 10 patients who did not have this degree of adrenergic activation. In addition, beta-adrenoreceptor affinity for isoproterenol was decreased in the three patients in whom intraaortic balloon pumping was mandatory after discontinuation of cardiopulmonary bypass. We suggest that this decreased affinity of lymphocyte beta-adrenergic receptors could be related, at least in part, to a sustained adrenergic activation occurring in some patients during cardiopulmonary bypass.
为评估对儿茶酚胺生物活性至关重要的β-肾上腺素能受体功能在冠状动脉搭桥手术期间是否发生改变，我们对16例接受心肌血运重建的患者，在麻醉诱导前（对照）和体外循环结束时，测量了淋巴细胞β-肾上腺素能受体的密度和亲和力。β-肾上腺素能受体密度和亲和力的变化在体外进行测定。还重复测定了血浆肾上腺素和去甲肾上腺素浓度。总体而言，与对照值相比，体外循环结束时β-肾上腺素能受体的平均密度和亲和力未观察到显著改变。然而，在体外循环期间儿茶酚胺水平较高的6例患者中，发现对异丙肾上腺素的亲和力显著降低（p<0.05）。相比之下，在未发生这种程度肾上腺素能激活的10例患者中，未观察到β-肾上腺素能受体对异丙肾上腺素的亲和力有显著改变。此外，在体外循环停止后必须进行主动脉内球囊反搏的3例患者中，β-肾上腺素能受体对异丙肾上腺素的亲和力降低。我们认为，淋巴细胞β-肾上腺素能受体亲和力降低可能至少部分与某些患者在体外循环期间发生的持续性肾上腺素能激活有关。
