Cardiopulmonary bypass alters vasomotor regulation of the skeletal muscle microcirculation
Cardiopulmonary bypass alters vasomotor regulation of the skeletal muscle microcirculation
复制标题
DOI：
10.1016/s0003-4975(97)00539-0
复制
发表时间：
1997-08-01
影响因子：
4.6
通讯作者：
Sellke, FW
中科院分区：
文献类型：
--
作者：
Stamler, A;Wang, SY;Sellke, FW
背景。体外循环（CPB）与器官灌注和血管通透性调节的改变有关。本研究旨在探讨低温CPB对骨骼肌微循环的调节作用及启动液的调节作用。将绵羊置于低温CPB中，其质料为五astarch羟基乙基淀粉（HS）溶液（n = 7）， HS与去铁胺偶联的溶液（n = 7）或林格乳酸溶液（n = 7）。将绵羊置于低温CPB（27摄氏度）中90分钟，同时用冷血心脏截瘫保护心脏。然后将绵羊从CPB中分离出来，再灌注3小时。测量血流动力学和总含水量。研究了薄股肌小动脉（70 ~ 180 μ m）对内皮依赖性药物乙酰胆碱、内皮非依赖性环gmp介导的血管舒张剂硝普钠、β -肾上腺素能激动剂异丙肾上腺素和腺苷酸环化酶激活剂福斯克林的体外松弛反应。各组间血流动力学差异无统计学意义。然而，与使用林格氏乳酸相比，当引物溶液为HS或HS-去铁胺时，体重增加明显更少。经CPB后，HS和乳酸林格氏盐组骨骼肌动脉对内皮依赖性血管扩张剂乙酰胆碱和β -肾上腺素能激动剂异丙肾上腺素的松弛作用减弱。hs -去铁胺组保留了乙酰胆碱的反应，而异丙肾上腺素的反应仍然受损。各组患者对硝普钠和福斯克林的反应相似。骨骼肌微血管内皮依赖性松弛和β -肾上腺素能松弛在CPB使用晶体或HS prime后减少。骨骼肌微血管内皮功能障碍可能归因于氧源性自由基介导的损伤，而CPB期间β -肾上腺素能调节的改变可归因于氧源性自由基产生以外的机制。(C) 1997年由胸外科学会出版。
Background. Cardiopulmonary bypass (CPB) is associated with alterations in the regulation of organ perfusion and vascular permeability. The purpose of this study was to examine the effects of hypothermic CPB on the regulation of the skeletal muscle microcirculation and the modulating influence of the priming solution.Methods. Sheep were placed on hypothermic CPB with a prime of either Pentastarch hydroxylethyl starch (HS) solution (n = 7), a solution in which HS is conjugated with deferoxamine (n = 7), or Ringer's lactate solution (n = 7). Sheep were placed on hypothermic CPB (27 degrees C) for 90 minutes while the heart was protected with cold blood cardioplegia. Sheep were then separated from CPB and perfused for an additional 3 hours off CPB. Hemodynamics and total water content were measured.Results. In vitro relaxation responses of gracilis muscle arterioles (70 to 180 mu m) to the endothelium-dependent agent acetylcholine, the endothelium-independent cyclic GMP-mediated vasodilator sodium nitroprusside, the beta-adrenergic agonist isoproterenol, and the adenylate cyclase activator forskolin were studied. No statistically significant hemodynamic differences were observed between groups. However, weight gain was significantly less when the priming solution was HS or HS-deferoxamine compared to when Ringer's lactate was used. Skeletal muscle arteriolar relaxations to the endothelium-dependent vasodilator acetylcholine and the beta-adrenergic agonist isoproterenol were impaired after CPB in the HS and Ringer's lactate groups. Acetylcholine response was preserved in the HS-deferoxamine group, whereas the response to isoproterenol remained impaired. The responses to sodium nitroprusside and forskolin were similar in all groups.Conclusions. Skeletal muscle microvascular endothelium-dependent relaxation and beta-adrenergic relaxation are reduced after CPB using either a crystalloid or HS prime. Skeletal muscle microvascular endothelial dysfunction may be attributable to oxygen-derived free radical-mediated injury, whereas altered beta-adrenergic regulation is attributable to mechanisms other than the generation of oxygen-derived free radicals during CPB. (C) 1997 by The Society of Thoracic Surgeons.