Chardigny C, Jebara V, Acar C, Descombes J J, Verbeuren T, Carpentier A, Fabiani J N
Département de Chirurgie cardio-vasculaire, Hôpital Broussais, Didot, Paris.
Chirurgie. 1994;120(9):494-502.
Recently, satisfactory results were obtained in a series of patients in whom the radial artery was used as a conduit for coronary artery bypass. However, spasm of this conduit was observed in four percent of patients. The aim of this study was to analyze the vasoreactive properties of the radial artery and to compare them to those of the internal mammary and the gastroepiploic arteries. Human radial (56 from n = 15 patients), internal mammary (77 from n = 20 patients) and gastroepiploic (41 from n = 12 patients) arteries ring segments were mounted on a strain gauge in oxygenated, normothermic, Krebs solution at optimal resting tension. With potassium chloride (100 mM) serving as the control, the dose response curves to norepinephrine, serotonin and thromboxane A2 mimetic were obtained, hence permitting to assess force of contraction and sensitivity. Functional endothelium was assessed by acetylcholine. Smooth muscle-dependent relaxation was assessed by sodium nitroprusside. The radial artery had stronger contractions to potassium chloride than the other vessels. The radial and the gastroepiploic arteries with endothelium presented a higher contraction force than the internal mammary artery in response to norepinephrine and serotonin. The gastroepiploic artery had a lower sensitivity to thromboxane A2 mimetic compared to the two other vessels. This increased reactivity of the radial artery explains its propensity to spasm and emphasizes the need for antispastic drugs and platelet inhibitors when the radial artery is used for coronary artery bypass.
最近，在一系列将桡动脉用作冠状动脉搭桥血管的患者中取得了令人满意的结果。然而，在4%的患者中观察到了该血管的痉挛。本研究的目的是分析桡动脉的血管反应特性，并将其与乳内动脉和胃网膜动脉的特性进行比较。将人桡动脉（来自15例患者的56段）、乳内动脉（来自20例患者的77段）和胃网膜动脉（来自12例患者的41段）的环段安装在应变仪上，置于充氧、常温的克雷布斯溶液中，并处于最佳静息张力。以氯化钾（100 mM）作为对照，获得去甲肾上腺素、5-羟色胺和血栓素A2模拟物的剂量反应曲线，从而评估收缩力和敏感性。通过乙酰胆碱评估功能性内皮。通过硝普钠评估平滑肌依赖性舒张。桡动脉对氯化钾的收缩比其他血管更强。有内皮的桡动脉和胃网膜动脉对去甲肾上腺素和5-羟色胺的反应呈现出比乳内动脉更高的收缩力。与其他两条血管相比，胃网膜动脉对血栓素A2模拟物的敏感性较低。桡动脉这种增加的反应性解释了其痉挛倾向，并强调在将桡动脉用于冠状动脉搭桥时需要使用抗痉挛药物和血小板抑制剂。
