Kalambokis Georgios, Economou Michalis, Paraskevi Kosta, Konstantinos Papadimitriou, Pappas Christos, Katsaraki Afroditi, Tsianos Epameinondas V
Department of Internal Medicine, Medical School, Ioannina, Greece.
J Gastroenterol Hepatol. 2005 Jul;20(7):1075-81. doi: 10.1111/j.1440-1746.2005.03902.x.
Terlipressin and somatostatin are the most preferable agents for the control of variceal bleeding in cirrhotic patients. The present study evaluated the hemodynamic effects of somatostatin, terlipressin and somatostatin plus terlipressin in cirrhotic patients with portal hypertension, as well as the effect of each regimen on renal sodium excretion.
Twenty-four patients with esophageal varices were randomly assigned to receive either an intravenous infusion of a placebo (n = 12) or somatostatin 250 microg/h after an initial bolus of 250 microg (n = 12) for 60 min. Thereafter, each patient received an intravenous injection of terlipressin 2 mg while the intravenous infusion of either somatostatin or placebo was maintained. Portal and systemic hemodynamic parameters, assessed by Doppler sonography, and urinary sodium excretion were evaluated at baseline, 60 min after placebo or somatostatin, and 30 min after terlipressin.
Placebo had no effect on the patients studied. After terlipressin, portal vein velocity, portal flow volume and cardiac output (CO) significantly decreased (0.09 vs 0.15 m/s, 0.56 vs 1 L/min and 6.4 vs 7.6 L/min, respectively [values are medians]), while mean arterial pressure (MAP) and systemic vascular resistance significantly increased (103.3 vs 89.9 mmHg and 1541 vs 1108dyn.s/cm(5), respectively). Fractional sodium excretion significantly increased in patients without ascites (0.43 vs 0.16%) while it did not change in patients with ascites. Somatostatin did not alter portal hemodynamics whereas it significantly reduced MAP, heart rate (HR) and CO (86.9 vs 98.6 mmHg, 65 vs 73 bpm and 8.4 vs 9.1 L/min, respectively) and, in patients with ascites, sodium excretion (0.13 vs 0.23%). The addition of terlipressin to somatostatin induced similar changes to those observed after terlipressin alone. The magnitude of increase in MAP was significantly higher in patients receiving terlipressin alone than in those receiving somatostatin plus terlipressin (15 vs 5.3%), while CO was conversely affected (-28.5 vs-20.9%).
Combined treatment with somatostatin and terlipressin does not exert an additive portal hypotensive effect in cirrhotic patients as compared to terlipressin alone, whereas somatostatin alone may impair systemic hemodynamics. Compared with somatostatin, terlipressin exerts a more beneficial effect on renal sodium excretion in patients with or without ascites.
特利加压素和生长抑素是控制肝硬化患者静脉曲张出血的最优选药物。本研究评估了生长抑素、特利加压素及生长抑素联合特利加压素对肝硬化门静脉高压患者的血流动力学影响，以及每种治疗方案对肾钠排泄的影响。
24例食管静脉曲张患者被随机分为两组，一组静脉输注安慰剂（n = 12），另一组在初始静脉推注250μg生长抑素后，以250μg/h的速度静脉输注生长抑素60分钟（n = 12）。此后，在持续静脉输注生长抑素或安慰剂的同时，每组患者静脉注射2mg特利加压素。在基线、安慰剂或生长抑素输注60分钟后以及特利加压素注射30分钟后，通过多普勒超声评估门静脉和全身血流动力学参数，并评估尿钠排泄情况。
安慰剂对所研究的患者无影响。注射特利加压素后，门静脉流速、门静脉血流量和心输出量（CO）显著降低（分别为0.09 vs 0.15m/s、0.56 vs 1L/min和6.4 vs 7.6L/min [数值为中位数]），而平均动脉压（MAP）和全身血管阻力显著增加（分别为103.3 vs 89.9mmHg和1541 vs 1108dyn.s/cm(5)）。无腹水患者的尿钠排泄分数显著增加（0.43 vs 0.16%），而有腹水患者的尿钠排泄分数未改变。生长抑素未改变门静脉血流动力学，但显著降低了MAP、心率（HR）和CO（分别为86.9 vs 98.6mmHg、65 vs 73次/分钟和8.4 vs 9.1L/min），并且在有腹水的患者中，降低了钠排泄（0.13 vs 0.23%）。生长抑素联合特利加压素引起的变化与单独使用特利加压素后观察到的变化相似。单独接受特利加压素治疗的患者MAP升高幅度显著高于接受生长抑素联合特利加压素治疗的患者（15 vs 5.3%），而CO则相反（-28.5 vs -20.9%）。
与单独使用特利加压素相比，生长抑素联合特利加压素在肝硬化患者中未产生额外的门静脉降压作用，而单独使用生长抑素可能会损害全身血流动力学。与生长抑素相比，特利加压素对有或无腹水患者的肾钠排泄具有更有益的影响。
