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。
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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.
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.
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.
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.
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.
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.
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.
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.
Surgery. 2013 Sep;154(3):436-43. doi: 10.1016/j.surg.2013.05.016.
9
Autophagy gene fingerprint in human ischemia and reperfusion.
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.
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.
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