心脏停搏和体外循环后糖尿病患者的微血管功能障碍
Microvascular dysfunction in patients with diabetes after cardioplegic arrest and cardiopulmonary bypass.
作者信息
Feng Jun, Sellke Frank
机构信息
Division of Cardiothoracic Surgery, Department of Surgery, Cardiovascular Research Center, Rhode Island Hospital, Alpert Medical School of Brown University, Rhode Island Hospital, Rhode Island, USA *Both the authors contributed equally to the writing of this article.
出版信息
Curr Opin Cardiol. 2016 Nov;31(6):618-624. doi: 10.1097/HCO.0000000000000340.
Abstract
PURPOSE OF REVIEW
The purpose of the current review is to describe the changes of microvascular function in patients with diabetes after cardioplegic arrest and cardiopulmonary bypass (CPB) and cardiac surgery.
RECENT FINDINGS
Cardiac surgery, especially that involving cardioplegia and CPB, is associated with significant changes in vascular reactivity of coronary/peripheral microcirculation, vascular permeability, gene/protein expression, and programmed cell death, as well as with increased morbidity and mortality after surgical procedures. In particular, these changes are more profound in patients with poorly controlled diabetes.
SUMMARY
Because alterations in vasomotor regulation are critical aspects of mortality and morbidity of cardioplegia/CPB, a better understanding of diabetic regulation of microvascular function may lead to improved postoperative outcomes of patients with diabetes after cardioplegia/CPB and cardiac surgery.
摘要
综述目的
本综述的目的是描述糖尿病患者在心脏停搏、体外循环（CPB）及心脏手术后微血管功能的变化。
最新发现
心脏手术，尤其是涉及心脏停搏和CPB的手术，与冠状动脉/外周微循环的血管反应性、血管通透性、基因/蛋白质表达及程序性细胞死亡的显著变化相关，也与手术后发病率和死亡率增加有关。特别是，这些变化在糖尿病控制不佳的患者中更为明显。
总结
由于血管舒缩调节的改变是心脏停搏/CPB死亡率和发病率的关键因素，更好地了解糖尿病患者微血管功能的调节可能会改善糖尿病患者在心脏停搏/CPB及心脏手术后的术后结局。
相似文献
1
Microvascular dysfunction in patients with diabetes after cardioplegic arrest and cardiopulmonary bypass.心脏停搏和体外循环后糖尿病患者的微血管功能障碍
Curr Opin Cardiol. 2016 Nov;31(6):618-624. doi: 10.1097/HCO.0000000000000340.
2
Differential impairment of adherens-junction expression/phosphorylation after cardioplegia in diabetic versus non-diabetic patients.糖尿病患者与非糖尿病患者心脏停搏后黏附连接表达/磷酸化的差异损伤
Eur J Cardiothorac Surg. 2016 Mar;49(3):937-43. doi: 10.1093/ejcts/ezv202. Epub 2015 Jun 11.
3
Impaired coronary contraction to phenylephrine after cardioplegic arrest in diabetic patients.糖尿病患者心脏停搏后对去氧肾上腺素的冠状动脉收缩功能受损。
J Surg Res. 2018 Oct;230:80-86. doi: 10.1016/j.jss.2018.04.045. Epub 2018 May 22.
4
Enhanced coronary arteriolar contraction to vasopressin in patients with diabetes after cardiac surgery.心脏手术后糖尿病患者的冠状动脉小动脉对血管加压素的收缩增强。
J Thorac Cardiovasc Surg. 2018 Dec;156(6):2098-2107. doi: 10.1016/j.jtcvs.2018.05.090. Epub 2018 Jun 8.
5
Coronary flow and reactivity, but not arrhythmia vulnerability, are affected by cardioplegia during cardiopulmonary bypass in piglets.在仔猪体外循环期间，心脏停搏液会影响冠脉血流和反应性，但不会影响心律失常易感性。
J Cardiothorac Surg. 2013 Jun 19;8:157. doi: 10.1186/1749-8090-8-157.
6
Decreased coronary arteriolar response to K channel opener after cardioplegic arrest in diabetic patients.在心脏停搏后，糖尿病患者的冠状动脉小动脉对钾通道开放剂的反应降低。
Mol Cell Biochem. 2018 Aug;445(1-2):187-194. doi: 10.1007/s11010-017-3264-x. Epub 2018 Jan 5.
7
Myocardial VEGF expression after cardiopulmonary bypass and cardioplegia.体外循环和心脏停搏后心肌血管内皮生长因子的表达
Circulation. 1998 Nov 10;98(19 Suppl):II242-6; discussion II247-8.
8
A rat model of cardiopulmonary bypass with cardioplegic arrest and hemodynamic assessment by conductance catheter technique.一种采用心脏停搏液停搏的体外循环大鼠模型及通过电导导管技术进行血流动力学评估
Basic Res Cardiol. 2007 Nov;102(6):508-17. doi: 10.1007/s00395-007-0668-x. Epub 2007 Aug 2.
9
Diabetes and Cardioplegia.糖尿病与心脏停搏液
J Nat Sci. 2017 Jun;3(6).
10
Patients with uncontrolled hypertension subjected to cardiopulmonary bypass have altered coronary vasomotor responses to serotonin.未控制的高血压患者在接受心肺旁路手术后，其冠状动脉对 5-羟色胺的血管运动反应发生改变。
Surgery. 2024 Aug;176(2):274-281. doi: 10.1016/j.surg.2024.03.052. Epub 2024 May 15.
引用本文的文献
1
Protein kinase C and endothelial dysfunction in select vascular diseases.蛋白激酶C与特定血管疾病中的内皮功能障碍
Front Cardiovasc Med. 2025 Aug 25;12:1618343. doi: 10.3389/fcvm.2025.1618343. eCollection 2025.
2
Microvascular dysfunction following cardiopulmonary bypass plays a central role in postoperative organ dysfunction.体外循环后微血管功能障碍在术后器官功能障碍中起核心作用。
Front Med (Lausanne). 2023 Feb 14;10:1110532. doi: 10.3389/fmed.2023.1110532. eCollection 2023.
3
A Cardioplegic Solution with an Understanding of a Cardiochannelopathy.一种对心脏通道病有深入理解的心脏停搏液
Antioxidants (Basel). 2021 Nov 25;10(12):1878. doi: 10.3390/antiox10121878.
4
Glycemic control is not associated with neurocognitive decline after cardiac surgery.血糖控制与心脏手术后的神经认知下降无关。
J Card Surg. 2022 Jan;37(1):138-147. doi: 10.1111/jocs.16102. Epub 2021 Oct 28.
5
Coronary endothelial dysfunction prevented by small-conductance calcium-activated potassium channel activator in mice and patients with diabetes.小电导钙激活钾通道激活剂可预防小鼠和糖尿病患者的冠状动脉内皮功能障碍。
J Thorac Cardiovasc Surg. 2020 Dec;160(6):e263-e280. doi: 10.1016/j.jtcvs.2020.01.078. Epub 2020 Feb 19.
6
Enhanced Activity by NKCC1 and Slc26a6 Mediates Acidic pH and Cl Movement after Cardioplegia-Induced Arrest of db/db Diabetic Heart.高糖诱导的糖尿病 db/db 心脏停搏后， NKCC1 和 Slc26a6 介导的酸性 pH 和 Cl 运动增强。
Mediators Inflamm. 2019 Sep 8;2019:7583760. doi: 10.1155/2019/7583760. eCollection 2019.
7
Postoperative microcirculatory perfusion and endothelial glycocalyx shedding following cardiac surgery with cardiopulmonary bypass.体外循环心脏手术后的微循环灌注和内皮糖萼脱落。
Anaesthesia. 2019 May;74(5):609-618. doi: 10.1111/anae.14577. Epub 2019 Jan 27.
8
Impaired coronary contraction to phenylephrine after cardioplegic arrest in diabetic patients.糖尿病患者心脏停搏后对去氧肾上腺素的冠状动脉收缩功能受损。
J Surg Res. 2018 Oct;230:80-86. doi: 10.1016/j.jss.2018.04.045. Epub 2018 May 22.
9
Enhanced coronary arteriolar contraction to vasopressin in patients with diabetes after cardiac surgery.心脏手术后糖尿病患者的冠状动脉小动脉对血管加压素的收缩增强。
J Thorac Cardiovasc Surg. 2018 Dec;156(6):2098-2107. doi: 10.1016/j.jtcvs.2018.05.090. Epub 2018 Jun 8.
10
Diabetes and Cardioplegia.糖尿病与心脏停搏液
J Nat Sci. 2017 Jun;3(6).
本文引用的文献
1
Inactivation of Endothelial Small/Intermediate Conductance of Calcium-Activated Potassium Channels Contributes to Coronary Arteriolar Dysfunction in Diabetic Patients.内皮细胞钙激活钾通道小/中电导的失活促成糖尿病患者冠状动脉小动脉功能障碍。
J Am Heart Assoc. 2015 Aug 24;4(8):e002062. doi: 10.1161/JAHA.115.002062.
2
Cardiopulmonary Bypass Decreases Activation of the Signal Transducer and Activator of Transcription 3 (STAT3) Pathway in Diabetic Human Myocardium.体外循环减少糖尿病患者心肌中信号转导子和转录激活子3（STAT3）通路的激活。
Ann Thorac Surg. 2015 Nov;100(5):1636-45; discussion 1645. doi: 10.1016/j.athoracsur.2015.05.013. Epub 2015 Jul 28.
3
New continuous-flow total artificial heart and vascular permeability.新型连续流全人工心脏与血管通透性。
J Surg Res. 2015 Dec;199(2):296-305. doi: 10.1016/j.jss.2015.06.035. Epub 2015 Jun 18.
4
Differential impairment of adherens-junction expression/phosphorylation after cardioplegia in diabetic versus non-diabetic patients.糖尿病患者与非糖尿病患者心脏停搏后黏附连接表达/磷酸化的差异损伤
Eur J Cardiothorac Surg. 2016 Mar;49(3):937-43. doi: 10.1093/ejcts/ezv202. Epub 2015 Jun 11.
5
Diabetic hearts have lower basal urocortin levels that fail to increase after cardioplegic arrest: association with increased apoptosis and postsurgical cardiac dysfunction.糖尿病心脏的基础促肾上腺皮质激素原水平较低，在心脏停搏后无法升高：与细胞凋亡增加和术后心脏功能障碍相关。
J Thorac Cardiovasc Surg. 2014 Nov;148(5):2296-308. doi: 10.1016/j.jtcvs.2014.05.018. Epub 2014 May 14.
6
No evidence for activated autophagy in left ventricular myocardium at early reperfusion with protection by remote ischemic preconditioning in patients undergoing coronary artery bypass grafting.在接受冠状动脉旁路移植术的患者中，早期再灌注时左心室心肌中无自噬激活的证据，远程缺血预处理具有保护作用。
PLoS One. 2014 May 5;9(5):e96567. doi: 10.1371/journal.pone.0096567. eCollection 2014.
7
Altered apoptosis-related signaling after cardioplegic arrest in patients with uncontrolled type 2 diabetes mellitus.心脏停搏后未控制的 2 型糖尿病患者细胞凋亡相关信号改变。
Circulation. 2013 Sep 10;128(11 Suppl 1):S144-51. doi: 10.1161/CIRCULATIONAHA.112.000332.
8
Altered expression and activation of mitogen-activated protein kinases in diabetic heart during cardioplegic arrest and cardiopulmonary bypass.在心脏停搏和体外循环期间糖尿病心脏中丝裂原活化蛋白激酶的表达和激活改变。
Surgery. 2013 Sep;154(3):436-43. doi: 10.1016/j.surg.2013.05.016.
9
Autophagy gene fingerprint in human ischemia and reperfusion.人缺血再灌注中的自噬基因特征。
J Thorac Cardiovasc Surg. 2014 Mar;147(3):1065-1072.e1. doi: 10.1016/j.jtcvs.2013.04.042. Epub 2013 Jun 15.
10
Activation of the homeostatic intracellular repair response during cardiac surgery.心脏手术期间细胞内稳态修复反应的激活。
J Am Coll Surg. 2013 Apr;216(4):719-26; discussion 726-9. doi: 10.1016/j.jamcollsurg.2012.12.034. Epub 2013 Feb 13.
Zotero 插件