He G W
Department of Surgery, University of Hong Kong, Grantham Hospital, Aberdeen.
J Thorac Cardiovasc Surg. 1998 Jun;115(6):1321-7. doi: 10.1016/S0022-5223(98)70215-6.
Endothelium plays a key role in graft patency. My colleagues and I have developed a verapamil+nitroglycerin solution (balanced to pH 7.4) to prepare the radial artery without mechanical distention or dilation and have reported the efficacy of its antispastic action. This study was designed to investigate whether using this solution as part of the University of Hong Kong protocol to prepare the radial artery is more efficacious than papaverine solution in preserving endothelial function.
Ring segments of the radial artery taken from 25 patients undergoing coronary artery bypass grafting were studied in organ chambers. The endothelium-dependent relaxation, as the index of endothelial function, was examined by two mechanisms-receptor-mediated relaxation (by acetylcholine) and non-receptor-mediated relaxation (by calcium ionophore A23187) in U46619-induced contraction (10 nmol/L).
In the relaxation induced by either acetylcholine (27.3% +/- 5.0% [n = 7] vs 23.9% +/- 3.9% [n = 6],p = 0.6) or A23187 (62.9% +/- 6.0% [n = 13] vs 62.3% +/- 8.4% [n = 6],p = 0.96), there was no significant difference between the control radial arteries and those treated with the verapamil+nitroglycerin solution. In the papaverine-treated rings, acetylcholine-mediated relaxation was abolished (3.3% +/- 2.6% vs 23.9% +/- 3.9%,p < 0.001) and A23187-mediated relaxation was significantly reduced (39.7% +/- 5.2% vs 62.3% +/- 8.4%, p = 0.02) compared with verapamil+nitroglycerin treatment.
Use of verapamil+nitroglycerin solution to prepare the radial artery maximally preserves endothelial function. In contrast, papaverine impairs this function. Verapamil+nitroglycerin solution may be effectively and safely used to prepare the radial artery for coronary artery bypass grafting.
内皮在移植物通畅中起关键作用。我和我的同事研发了一种维拉帕米 + 硝酸甘油溶液（pH 值调至 7.4），用于在不进行机械扩张或 dilation 的情况下制备桡动脉，并报告了其抗痉挛作用的疗效。本研究旨在调查将该溶液作为香港大学方案的一部分用于制备桡动脉在保留内皮功能方面是否比罂粟碱溶液更有效。
对 25 例接受冠状动脉旁路移植术患者的桡动脉环段在器官腔室中进行研究。以内皮依赖性舒张作为内皮功能指标，通过两种机制——受体介导的舒张（通过乙酰胆碱）和非受体介导的舒张（通过钙离子载体 A23187），在 U46619 诱导的收缩（10 nmol/L）中进行检测。
在由乙酰胆碱（27.3% ± 5.0% [n = 7] 对 23.9% ± 3.9% [n = 6]，p = 0.6）或 A23187（62.9% ± 6.0% [n = 13] 对 62.3% ± 8.4% [n = 6]，p = 0.96）诱导的舒张中，对照桡动脉与用维拉帕米 + 硝酸甘油溶液处理的桡动脉之间无显著差异。与维拉帕米 + 硝酸甘油处理相比，在罂粟碱处理的环中，乙酰胆碱介导的舒张被消除（3.3% ± 2.6% 对 23.9% ± 3.9%，p < 0.001），且 A23187 介导的舒张显著降低（39.7% ± 5.2% 对 62.3% ± 8.4%，p = 0.02）。
使用维拉帕米 + 硝酸甘油溶液制备桡动脉能最大程度地保留内皮功能。相比之下，罂粟碱会损害该功能。维拉帕米 + 硝酸甘油溶液可有效且安全地用于制备用于冠状动脉旁路移植术的桡动脉。
