不同扩张液在冠状动脉旁路移植术中对大隐静脉内皮细胞保护的对比研究

A Comparative Study of Different Distention Solutions and Their Preservation of Greater Saphenous Vein Endothelial Cells during CABG Surgery

目的:对比研究不同扩张液对大隐静脉内皮细胞保护作用,探讨其临床应用价值。方法:连续90例行冠状动脉旁路移植术(CABG)的患者被随机分为三硝酸甘油-维拉帕米组(GV组,n=28)、罂粟碱组(Pap组,n=32)以及空白对照组(n=30)。常规扩张离取后的大隐静脉,各组的扩张液各不相同。测量扩张过程中扩张压力的峰值,扩张后单位面积血管内皮细胞(VEC)的死亡数目,以及扩张后单位面积VEC合成释放一氧化氮(NO)的量。结果:3组扩张液扩张后均可见大隐静脉内膜VEC的死亡,以及中膜血管平滑肌的撕裂。但是GV组扩张压力峰值和单位面积VEC死亡数目明显小于Pap组和空白对照组(P<0.05),而单位内皮合成释放NO量明显高于Pap组和空白对照组(P<0.05)。结论:大隐静脉离取后扩张是损伤血管内膜的过程,GV组扩张液能明显降低扩张大隐静脉所需的压力,并且能最大限度的保护VEC和血管内膜的完整性,在具体的临床应用上能提高大隐静脉桥的远期通畅率。

Objective: To compare different distention solutions and their pr es ervation effects on endothelial cells of greater saphenous vein (GSV). Methods: Consecutive ninety patients with isolated coronary artery bypass grafting (CABG) surgery were enrolled into three groups randomly: the Glyceryl Trinitrate-Vera pamil group (GV group,n=32), Papaverine group (Pap group, n=28) and control gro up (n=30). The harvested greater saphenous veins were routinely distended, and t he distention solution of each group was different. The peak distention pressure during distention, the numbers of dead vascular endothelial cells (VECs) per un it area and the dose of nitric oxide (NO) synthesized and released per unit area after distention were measured. Results: The dead VECs and even the laceration of vascular smooth muscle cells (VSMCs) in the tunica media of all three groups were noted. But the peak distention pressure in GV group was lower than that in the Pap and control group (P< 0.05), the numbers of dead vascular endothelial ce lls per unit area in the GV group was remarkably fewer than that in the Pap and control group (P< 0.05), while the dose of NO synthesized and released in per un it area was much higher than that in the Pap and control group (P< 0.05). Conclu sion: Distention after GSV harvesting is a trauma process on VECs. GV distention solution can remarkbly reduce the pressure which can meet the needs of expansio n in GSV, and can maximally preserve the VEC and the integrality of the vascular endothelium, which can theoretically improve the long patency of the GSV graft. [