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低温体外循环后骨骼肌小动脉肌源性反应性降低。

Decreased myogenic reactivity in skeletal muscle arterioles after hypothermic cardiopulmonary bypass.

作者信息

Wang S Y, Stamler A, Li J, Johnson R G, Sellke F W

机构信息

Department of Surgery, Beth Israel-Deaconess Medical Center, Boston, Massachusetts, USA.

出版信息

J Surg Res. 1997 Apr;69(1):40-4. doi: 10.1006/jsre.1997.5020.

DOI:10.1006/jsre.1997.5020
PMID:9202644
Abstract

Cardiopulmonary bypass (CPB) is associated with a generalized defect in the intrinsic control of vascular smooth muscle. To determine if myogenic reactivity of skeletal muscle arterioles was altered by CPB, sheep (n = 7) were placed on hypothermic CPB (27 degrees C) for 90 min and hearts were arrested by cold blood cardioplegia ([K+] = 25 mM) for 60 min. Arterioles (70-180 microns) were isolated from the gracilis muscle before (control) and 15 min after CPB. In vitro arteriolar responses were studied with video-microscopy. Myogenic reactivity was examined to stepwise increases in intraluminal pressure from 10 to 100 mm Hg. Mean arterial pressure was decreased from 80 +/- 15 prior to CPB to 55 +/- 4 mm Hg (P < 0.01) 15 min after CPB. Myogenic contraction was observed in control vessels and was markedly attenuated by the protein kinase C inhibitor staurosporine (P < 0.01). CPB decreased myogenic contraction and shifted the pressure-diameter relation upward, suggesting a decrease in the intrinsic tone (both P < 0.05 vs control). CPB reduced contractile responses to the alpha 1-adrenoceptor agonist phenylephrine from -43 +/- 7% to -23 +/- 5% (P < 0.01) and the protein kinase C activator 12-deoxyphorbol 13-isobutyrate 20-acetate (phorbol ester) from -64 +/- 6% to -38 +/- 16% (P < 0.01). CPB-associated decrease in myogenic reactivity of skeletal muscle arterioles is likely due to alterations in protein kinase C and/or downstream signal transduction. This may account in part for reduction in systemic vascular resistance and hypotension associated with CPB.

摘要

体外循环(CPB)与血管平滑肌内在控制的普遍缺陷有关。为了确定CPB是否会改变骨骼肌小动脉的肌源性反应性,将绵羊(n = 7)置于低温CPB(27℃)下90分钟,并用冷血心脏停搏液([K +] = 25 mM)使心脏停搏60分钟。在CPB前(对照)和CPB后15分钟从股薄肌分离出小动脉(70 - 180微米)。用视频显微镜研究体外小动脉反应。检查肌源性反应性,观察管腔内压力从10逐步增加到100 mmHg时的情况。平均动脉压在CPB前为80±15 mmHg,在CPB后15分钟降至55±4 mmHg(P < 0.01)。在对照血管中观察到肌源性收缩,并且蛋白激酶C抑制剂星形孢菌素可使其明显减弱(P < 0.01)。CPB降低了肌源性收缩,并使压力 - 直径关系向上移动,表明内在张力降低(两者与对照相比P < 0.05)。CPB使对α1 - 肾上腺素能受体激动剂去氧肾上腺素的收缩反应从 - 43±7%降至 - 23±5%(P < 0.01),使蛋白激酶C激活剂12 - 脱氧佛波醇13 - 异丁酸酯20 - 乙酸酯(佛波酯)的收缩反应从 - 64±6%降至 - 38±16%(P < 0.01)。CPB相关的骨骼肌小动脉肌源性反应性降低可能是由于蛋白激酶C和/或下游信号转导的改变。这可能部分解释了与CPB相关的全身血管阻力降低和低血压。

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