Shawcross Debbie L, Davies Nathan A, Mookerjee Rajeshwar P, Hayes Peter C, Williams Roger, Lee Alistair, Jalan Rajiv
Liver Failure Group, Institute of Hepatology, Royal Free and University College London Medical School, London, UK.
Hepatology. 2004 Feb;39(2):471-5. doi: 10.1002/hep.20044.
There is increasing evidence that terlipressin is useful in patients with cirrhosis and hepatorenal syndrome, but there are no data of its use in patients with acute liver failure (ALF) in whom hepatorenal syndrome is common. Although terlipressin produces systemic vasoconstriction, it produces cerebral vasodilatation and may increase cerebral blood flow (CBF). Increased CBF contributes to intracranial hypertension in patients with ALF. The aim of this study was to evaluate the safety of terlipressin in patients with ALF with respect to cerebral hemodynamics. Six successive patients with ALF were ventilated electively for grade IV hepatic encephalopathy. Patients were monitored invasively and CBF was measured (Kety-Schmidt technique). Measurements were made before and at 1, 3, and 5 hours after intravenous (single bolus) administration of terlipressin (0.005 mg/kg), median, 0.25 mg (range, 0.2-0.3 mg). There was no significant change in heart rate, mean arterial pressure, or cardiac output. CBF and jugular venous oxygen saturation both increased significantly at 1 hour (P = 0.016). Intracranial pressure increased significantly at 1 hour (P = 0.031), returning back to baseline values at 2 hours. In conclusion, administration of terlipressin, at a dose that did not alter systemic hemodynamics, resulted in worsening of cerebral hyperemia and intracranial hypertension in patients with ALF and severe hepatic encephalopathy. These data suggest the need to exercise extreme caution in the use of terlipressin in these patients in view of its potentially deleterious consequences on cerebral hemodynamics.
越来越多的证据表明，特利加压素对肝硬化和肝肾综合征患者有用，但尚无其用于急性肝衰竭（ALF）患者的数据，而肝肾综合征在ALF患者中很常见。尽管特利加压素会引起全身血管收缩，但它会导致脑血管扩张，并可能增加脑血流量（CBF）。脑血流量增加会导致ALF患者颅内压升高。本研究的目的是评估特利加压素在ALF患者中对脑血流动力学的安全性。连续6例ALF患者因IV级肝性脑病接受选择性通气。对患者进行有创监测并测量脑血流量（凯蒂-施密特技术）。在静脉注射（单次推注）特利加压素（0.005mg/kg，中位数为0.25mg，范围为0.2 - 0.3mg）前以及给药后1、3和5小时进行测量。心率、平均动脉压或心输出量无显著变化。脑血流量和颈静脉血氧饱和度在1小时时均显著增加（P = 0.016）。颅内压在1小时时显著升高（P = 0.031），在2小时时恢复到基线值。总之，在不改变全身血流动力学的剂量下给予特利加压素，会导致ALF和严重肝性脑病患者的脑充血和颅内压升高恶化。鉴于其对脑血流动力学可能产生的有害后果，这些数据表明在这些患者中使用特利加压素时需要极其谨慎。
