Lin H C, Tsai Y T, Lee F Y, Chang T T, Wang S S, Lay C S, Lee S D, Lo K J
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
J Hepatol. 1990 May;10(3):370-4. doi: 10.1016/0168-8278(90)90149-l.
We measured the haemodynamic changes following triglycyllysine vasopressin administration and after addition of nitroglycerin in twelve patients with portal hypertension due to hepatitis B-related cirrhosis. A bolus i.v. injection of triglycyllysine vasopressin at a dose of 2 mg reduced the hepatic venous pressure gradient from 18.5 +/- 3.7 (mean +/- S.D.) to 15.6 +/- 4.0 mmHg, p less than 0.001. However, the cardiac index decreased from 4.8 +/- 1.0 to 3.7 +/- 0.8 l/min m2, p less than 0.001; the heart rate decreased from 79 +/- 15 to 71 +/- 13, p less than 0.01; the right atrial pressure increased from 3.2 +/- 1.9 to 5.3 +/- 2.3 mmHg, p less than 0.001; the mean arterial pressure increased from 92 +/- 13 to 103 +/- 13 mmHg, p less than 0.05; and the systemic vascular resistance rose from 939 +/- 182 to 1367 +/- 310 dyn/s cm-5, p less than 0.001. Furthermore, both mean pulmonary arterial pressure and pulmonary capillary wedge pressure showed a significant increase following triglycyllysine vasopressin administration as compared with baseline values (p less than 0.005). The addition of sublingual nitroglycerin at a dose of 0.6 mg returned all the systemic haemodynamic parameters to baseline levels. On the other hand, nitroglycerin administration caused no further change in the hepatic venous pressure gradient. We concluded that although triglycyllysine vasopressin significantly reduced portal pressure in patients with hepatitis B-related cirrhosis, it produced untoward systemic haemodynamic changes similar to those seen with vasopressin. The addition of nitroglycerin improved the detrimental systemic haemodynamic effects produced by triglycyllysine vasopressin without further reducing the hepatic venous pressure gradient.
我们对12例乙型肝炎相关肝硬化所致门静脉高压患者，测定了给予三甘氨酰赖氨酸加压素后以及加用硝酸甘油后的血流动力学变化。静脉推注2mg三甘氨酰赖氨酸加压素，可使肝静脉压力梯度从18.5±3.7（均值±标准差）降至15.6±4.0mmHg，p<0.001。然而，心脏指数从4.8±1.0降至3.7±0.8l/min·m²，p<0.001；心率从79±15降至71±13，p<0.01；右心房压力从3.2±1.9升至5.3±2.3mmHg，p<0.001；平均动脉压从92±13升至103±13mmHg，p<0.05；全身血管阻力从939±182升至1367±310dyn/s·cm⁻⁵，p<0.001。此外，与基线值相比，给予三甘氨酰赖氨酸加压素后平均肺动脉压和肺毛细血管楔压均显著升高（p<0.005）。舌下含服0.6mg硝酸甘油可使所有全身血流动力学参数恢复至基线水平。另一方面，给予硝酸甘油未使肝静脉压力梯度进一步改变。我们得出结论，尽管三甘氨酰赖氨酸加压素可显著降低乙型肝炎相关肝硬化患者的门静脉压力，但它会产生与加压素类似的不良全身血流动力学变化。加用硝酸甘油可改善三甘氨酰赖氨酸加压素所致的有害全身血流动力学效应，而不会进一步降低肝静脉压力梯度。
