Saeki Y, Nagatomi N, Kobayashi T, Hiratani S, Shiomi S, Arakawa T, Kamata T, Kobayashi K
Third Department of Internal Medicine, Osaka City University Medical School, Japan.
Gastroenterol Jpn. 1991 Jul;26 Suppl 3:90-2. doi: 10.1007/BF02779273.
In patients with portal hypertension, bleeding from the gastric mucosa is common, and is often treated with vasopressin (VP). VP reduces the portal pressure by contracting the arterioles of the abdominal organs. In normal rats, VP reduces the gastric mucosal blood flow (GMBF). However, it is not sure whether the reduction of the portal pressure by VP actually reduces the GMBF in patients with portal hypertension. Here, we studied the effects of VP on the GMBF of 24 patients with portal hypertension resulting from cirrhosis. The ICG15 test was done for 20 of the patients. We measured the GMBF of the antrum and body of the stomach using a laser Doppler flowmeter (Peliflux PF 2) connected with a gastrofiberscope without VP on one day and about 10 min after the start of administration of VP (0.4 U/min, i.v.) on another day. Unexpectedly, the GMBF was increased with VP in 14 of 22 patients at the antrum and in 19 of 24 patients at the body of the stomach. In the body of the stomach, there was correlation between the increase in the GMBF caused by VP and the results of the ICG15 test. A high ICG15 reflects high portal pressure, so this finding indicates that in high portal pressure, the GMBF is increased by VP, and in low portal pressure, the GMBF is decreased by VP.
在门静脉高压患者中，胃黏膜出血很常见，且常采用血管加压素（VP）进行治疗。VP通过收缩腹部器官的小动脉来降低门静脉压力。在正常大鼠中，VP会减少胃黏膜血流量（GMBF）。然而，尚不确定VP降低门静脉压力是否真的能减少门静脉高压患者的GMBF。在此，我们研究了VP对24例肝硬化所致门静脉高压患者GMBF的影响。对其中20例患者进行了吲哚菁绿15分钟滞留率（ICG15）试验。我们使用与胃镜相连的激光多普勒血流仪（Peliflux PF 2），在一天未使用VP时以及在另一天开始静脉输注VP（0.4 U/分钟）约10分钟后，测量胃窦和胃体的GMBF。出乎意料的是，在22例患者中的14例胃窦部以及24例患者中的19例胃体部，VP使GMBF增加。在胃体部，VP引起的GMBF增加与ICG15试验结果之间存在相关性。高ICG15反映高门静脉压力，所以这一发现表明，在门静脉压力高时，VP使GMBF增加，而在门静脉压力低时，VP使GMBF减少。
