乌拉地尔和西咪替丁对门静脉高压症患者肝静脉及全身血流动力学影响的研究  

Effects of urapidil and cimetidine on wedged hepatic venous pressure and systemic hemodynamics in cirrhotic patients with portal hypertension

作　　者：李澍[1] 冯洪强[1] 朱继业[1] 钟朝晖[1] 冷希圣[1] 杜如昱[1] 

机构地区：[1]北京医科大学人民医院普通外科,100044

出　　处：《中华外科杂志》2000年第4期287-290,共4页Chinese Journal of Surgery

摘　　要：目的　比较乌拉地尔和西咪替丁对肝硬化门静脉高压症患者门静脉压力及全身血流动力学的影响。　方法　对 45例肝硬化门静脉高压症患者分别应用乌拉地尔 (n =15 )、西咪替丁 (n =2 0 )和 0 9%氯化钠盐水 (n =10 )后观察其肝静脉楔入压 (WHVP)、肝静脉压力梯度 (HVPG)及全身血流动力学的影响。　结果　经周围静脉输入乌拉地尔 2 5mg后 ,WHVP平均降低 (2 8 75± 9 81) % (P <0 0 1) ;HVPG平均降低 (35 81± 8 71) % (P <0 0 1) ,而自由肝静脉压 (FHVP)无明显改变。输注乌拉地尔后心率平均增加 (12 86± 6 0 5 ) % (P <0 0 5 )。收缩压和舒张压分别下降了 (2 2 0 0± 11 2 4) %和(2 7 0 1± 12 15 ) % (P <0 0 1)。经周围静脉输注西咪替丁 40 0mg后 ,WHVP平均降低 (15 18± 8 6 4) %(P <0 0 1) ;HVPG(2 6 0 0± 12 19) % (P <0 0 1) ;但心率、血压及FHVP在用药前后无明显变化 (P >0 0 5 )。对照组给以 0 9%氯化钠后 ,WHVP ,HVPG ,FHVP以及全身血流动力学参数均无明显改变。　结论　乌拉地尔和西咪替丁均可以明显降低WHVP和HVPG ,二者降压效果差异无显著性 。ObjectiveTo compare the effects of urapidil and cimetidine on portal pressure and systemic hemodynamics. Methods We observed the effects of urapidil (urapidil HCl, n =15), cimetidine ( n =20) and placebo (0 9% sodium chloride, n =10) on wedged hepatic venous pressure (WHVP), hepatic venous pressure gradient (HVPG), and systemic hemodynamics. Results Urapidil at a dosage of 25 mg intravenously reduced WHVP from 33 33±7 85 cm H 2O to 23 75±6 83 cm H 2O, tho average value was 28 75%±9 81% ( P <0 01); and HVPG from 21.92±2 34 cm H 2O to 14 07±3 57 cm H 2O, the average value was 35 81%±8 71% ( P <0 01). The free hepatic venous pressure (FHVP) however was not changed significantly ( P >0 05). The heart rate was increased from 70±13 BPM to 79±21 BPM ( P <0 05), and the systolic blood pressure and the diastolic blood pressure were reduced from 122±40 mm Hg to 95±32 mm Hg and 75 ±17 mm Hg to 55±15 mm Hg respectively ( P <0 01). After cimetidine administered at a dosage of 400 mg intravenously, WHVP and HVPG were reduced from 34 25±7 34 cm H 2O to 29 05 ±7 03 cm H 2O and 23 14±8 15 cm H 2O to 17 13±4 28 cm H 2O; and the average value was 15 18%±8 64% and 26 00%±12 19% respectively ( P <0 01). But heart rate, blood pressure and FHVP were not altered after use of cimetidine ( P >0 05). In the control group ( n =10), WHVP, HVPG, FHVP, heart rate, as well as blood pressure were not changed after placebo treatment. ]Conclusions Both urapidil and cimetidine could reduce WHVP and HVPG significantly in cirrhotic patients with portal hypertension, and the effect of the two agents on WHVP and HVPG was not obviously different ( P >0 05). However, the systemic hemodynamic effects induced by urapidil were more significant compared with cimetidine.

关 键 词：血流动力学 神经递质药 肝硬化 门脉高压症 

分 类 号：R605[医药卫生—外科学]