缩/扩血管活性药物合用对肝硬化门体循环及肝动脉血流动力学的影响  

Effects of the combination ofvasoactive drugs on portohepatic and systemic haemodynamics in the patients with hepatic cirrosis

作　　者：许洪伟[1] 孙洪军[1] 张国全[2] 张春清[1] 秦成勇[1] 徐麟[1] 

机构地区：[1]山东省立医院消化科,济南250021 [2]山东省立医院超声诊疗中心,济南250021

出　　处：《胃肠病学和肝病学杂志》2004年第5期521-524,共4页Chinese Journal of Gastroenterology and Hepatology

摘　　要：目的　探讨血管活性药物血管收缩剂垂体后叶素 (VP)单用及与血管扩张剂硝酸甘油 (NTG)联合用药对肝硬化患者门脉系统、肝动脉及体循环血流动力学参数的影响。方法　应用多普勒超声技术检测 41肝硬化患者VP单用及与NTG联合用药时门静脉血流量 (Qpv)、肝动脉阻力指数 (RI)和体循环平均动脉压 (MAP)、心率 (HR)的变化 ;评价其与Child_Pugh肝功能分级的关系。结果　A、B、C三级肝硬化组对VP反应性相同 ,表现为QPV血流量较基础水平明显减少 (P <0 0 0 1) ,而降低幅度相近 ,约 40 % (P >0 0 5 ) ;加用NTG后均未见Qpv进一步减低或增加。A、B、C三级肝硬化患者应用VP静滴后 ,肝动脉RI均显著增加 (P <0 0 1) ;联合应用NTG后 ,RI较单用VP时有所降低 (P <0 0 5 ) ,但与用药前的基础水平相比 ,RI仍有所升高 (P <0 0 5 )。VP静滴 15min后 ,MAP升高 14 4% ,HR降低 5 2 % ;加用NTG后 ,MAP较VP用药水平降低 10 7%、HR增加 10 5 % (P <0 0 0 1) ,而且与用药前的基础水平比较无显著性差异。结论　不同程度的肝硬化 ,其门脉系统血流动力学对VP的敏感性一致 ,门脉高压程度不影响VP降低门脉血流的效应。NTG在VP通过降低门脉血流量发挥降低门脉压方面无相加作用 ;但作为血管扩张剂 ,NTG亦无拮抗VP的作用。Objective To evaluate effects of vasopressin(VP) and vasopressin plus nitroglycerin(NTG) on portohepatic and systemic hemodynamics in the patients with hepatic cirrosis.Methods With pulsed Doppler(PD) ultrasonography guided by color doppler flow imaging(CDFI),the effects of VP and VP plus NTG on the portal venous flow (Qpv) and resistant index(RI) of hepatic artery, and relations between the effects and Child_pugh classification were evaluated in 41 patients with hepatic cirrhosis.Alteration of mean arterial pressure(MAP) and heart rate(HR) were detected in addition.Results At a VP rate of 0.3 u/min,Qpv of grade A,B,C were significantly decreased by 40% approximately (P<0.001),and the levels of reduction were not significantly different(P>0.05).Addition of NTG to VP had no effect on alteration of Qpv.Compared with VP alone,RI was reduced significantly in VP plus NTG (P<0.05),but not reversed entirely to basic level.When administration of VP for 15 min,MAP increased by 14.4% whereas HR decreased by 5.2%.In contrast,the combination of VP and NTG showed that MAP decreased by 10.7% and HR decreased by 10.5% as near to basic levels.Conclusion The results indicated that the effects of VP on the portal hemodynamics in cirrhotic patients with grade A、B、C were similar.Addition of NTG to VP could not increase/decrease Qpv,but partly reverse reduction of hepatic artery flow induced by VP alone.VP plus NTG could reverse entirely or avoid the adverse effects of VP on systemic circulation.

关 键 词：肝动脉 NTG 体循环 肝硬化患者 血流动力学 RI 联合用药 水平 拮抗 平均动脉压 

分 类 号：R575.2[医药卫生—消化系统] R735[医药卫生—内科学]