Abstract: Objective To compare the effects of nitroglycerine (NTG)， Verapamil(VP), papaverine(PA) and the mixed solution of Verapamil and nitroglycerine (VG) on relaxing function of human radial arteries. Methods The radial arteries of thirty patients were used during the operation of coronary artery bypass grafting (CABG). A short segment (1.0-1.5cm) of radial arteris were taken from the distal end of radial arteries of each patient and were cut into vascular rings, which were mounted in the organ bath chamber and then subject to a series of tests for vascular smooth muscle viability and endothelial integrity. The effects of five storage solutions on the relaxing function were evaluated by “OrganBath” technique. The five solutions included: (1) Ringer’ s solution (control group); (2) VP solution (VP group); (3) NTG solution (NTG group); (4) PA solution (PA group); (5) VG solution (VG group). First, challenged with phenylephrine (10-5mol/L), vasorelaxant effect of these drugs (effect onset and efficacy) was observed at different time point and resting tension was recorded. Second, after 30min preincubation with either verapamil, papaverine, phenoxybenzamine or VG mixture, potassium chloride (final concentration of 60mmol/L) was added in the organ bath chamber and then vasoconstriction was observed subsequently. Finally, after 30min pretreatment of different antispasmodic agent in the same way as described above, the vascular rings were mounted in organ bath chamber and challenged with phenylephrine(10-5mol/L). Vascular spasticity and vosospasm duration were observed at different time point which might provide guidance for optimal timing of clinical application. Results The radial arteries in VG, VP, NTG and PA solutions were relaxed in 11 min after vasospasm and there was no difference between them (Pgt;0.05). But during the initial three minutes，the relaxation effect of VG and NTG was significantly better than other two groups. Relaxation curve showed that the ability of vasodilatation of VG, NTG, VP and PA decreased in order. In the experiment about antivasospasm pretreatment of radial arteries, there was no difference between VG and VP group (Pgt;0.05 ), whose effects were better than NTG and PA group(Plt;0.05 ). After cold storage for 24h, VG and VP still could prevent vasospasm. But NTG and PA hardly had any function and there was no difference compared with the control group (Pgt;0.05 ). Conclusion Although in the final all these drugs could prevent and relieve vasospasm of radial arteries in the different level, it appeared that a combination of verapamil and nitroglycenn is more fit for treating radial artery during CABG operation than other drugs.
ObjectiveTo explore clinical outcomes of papaverine via the aortic root under cardiopulmonary bypass (CPB) in coronary artery bypass grafting. MethodsA total of 263 patients with coronary artery disease underwent CPB in coronary artery bypass grafting in Beijing Anzhen Hospital from August 2003 through December 2014 were included. According to whether or not they received papaverine perfusion via the aortic root in the first perfusion during CPB, all the 263 patients were divided into two groups including an intervention group and a control group. There were 176 patients in the intervention group including 109 males and 67 females with their average age of 64.37±23.54 years. They received aortic root perfusion of 60 mg papaverine diluted into 20 ml during the first perfusion, and repeated aspiration was performed 8 to 10 times in CPB when the heart beat weak. In the control group, there were 87 patients including 55 males and 32 females with their average age of 65.98±29.13 years. Patients in the control group received routine procedures of CPB except papaerine perfusion. Clinical effectiveness was compared between the two groups. ResultsThere was no in-hospital death. CPB supporting time after heart re-beating (9.58±3.21 min vs. 19.74±5.67 min, t=-1.133, P=0.000), dopamine usage 3.12±1.27 μg/(kg·min) vs. 4.98±2.53 μg/(kg·min),t=-0.913, P=0.031), epinephrine usage 0.018±0.009 μg/(kg·min) vs. 0.047±0.011 μg/(kg·min), t=-0.811, P=0.018) and nor epinephrine usage 0.021±0.011 μg/(kg·min) vs. 0.037±0.010 μg/(kg·min), t=-0.823, P=0.019) of the intervention group were significantly shorter or lower than those of the control group. Automatic heart re-beating rate of the intervention group was significantly higher than that of the control group (98.86% vs. 70.11%,t=-1.372, P=0.000). A total of 176 patients in the nitroglycerin group were followed up for 6-121 months, and 16 patients were lost during follow-up. During the follow-up period, 6 patients were hospitalized for cardiac events, and 2 died in 29 months and 103 months after surgery, and 9 died from cardiac events. ConclusionFor the patients undergoing on-pump coronary artery bypass grafting, some myocardial protection strategies including papaverine perfusion via the aortic root in the first perfusion, use of norepinephrine, and aortic root squeezing in high frequency by hand can significantly increase the automatic heart re-beating rate, shorten the CPB supporting time after heart re-beating, and improve postoperative clinical outcomes.