Department of Clinical Physiology and Nuclear Medicine, Faculty of Health Sciences, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
Eur J Gastroenterol Hepatol. 2011 Apr;23(4):334-42. doi: 10.1097/MEG.0b013e3283455b7f.
Patients with cirrhosis often exhibit abnormalities in cardiovascular regulation and oxygenation. Many of these patients are treated with β-blockers and aldosterone antagonists that may influence the regulation of systemic haemodynamics, but the specific effects on systemic haemodynamics and oxygenation are less studied. We therefore investigated systemic haemodynamics and oxygenation in patients with cirrhosis before and after 3 weeks of treatment with propranolol or spironolactone.
Twenty-two patients with cirrhosis were allocated into three groups as follows: a β-blocker group (n=7), a spironolactone group (n=8) and a control group (n=7). At baseline, and after 3 weeks, we measured the arterial blood pressure (BP), heart rate, Q-T frequency-corrected interval, baroreflex sensitivity, cardiac output, peripheral arterial inflow (ABFin), transcutaneous oxygenation and hormonal status. We also assessed immediate effects of propranolol in the β-blocker group.
Short-term and long-term β-blockade significantly reduced BP (-7%) and heart rate (-15%) (P<0.01). Short-term β-blocker treatment improved the Q-T frequency-corrected interval but reduced the transcutaneous oxygenation (P<0.05). Baroreflex sensitivity and brain natriuretic peptide increased after short-term and after 3 weeks of β-blocker treatments (P<0.01). After 3 weeks, β-blockers reduced cardiac output and ABFin by 13 and 26%, respectively (P<0.05-0.01). In the spironolactone group, BP decreased by 8% (P<0.05) and renin increased by 370% (P<0.01). No changes were seen in the control group.
Short-term and long-term treatments with β-blockers and aldosterone antagonist modestly affect haemodynamics and oxygenation. Careful monitoring, especially in patients with low arterial blood pressure, if cardiac dysfunction is suspected, should follow the administration of β-blockers.
肝硬化患者常伴有心血管调节和氧合异常。许多此类患者接受β受体阻滞剂和醛固酮拮抗剂治疗，这些药物可能影响全身血液动力学的调节，但具体的全身血液动力学和氧合作用的影响研究较少。因此，我们研究了肝硬化患者在接受普萘洛尔或螺内酯治疗 3 周前后的全身血液动力学和氧合作用。
22 例肝硬化患者分为三组：β受体阻滞剂组（n=7）、螺内酯组（n=8）和对照组（n=7）。在基线时和 3 周后，我们测量了动脉血压（BP）、心率、QT 频率校正间隔、压力反射敏感性、心输出量、外周动脉流入（ABFin）、经皮氧合和激素状态。我们还评估了β受体阻滞剂组中普萘洛尔的即时作用。
短期和长期β受体阻滞剂治疗显著降低了血压（-7%）和心率（-15%）（P<0.01）。短期β受体阻滞剂治疗改善了 QT 频率校正间隔，但降低了经皮氧合（P<0.05）。短期和 3 周β受体阻滞剂治疗后，压力反射敏感性和脑利钠肽增加（P<0.01）。3 周后，β受体阻滞剂使心输出量和 ABFin 分别减少了 13%和 26%（P<0.05-0.01）。螺内酯组中，血压降低 8%（P<0.05），肾素增加 370%（P<0.01）。对照组无变化。
短期和长期使用β受体阻滞剂和醛固酮拮抗剂治疗会适度影响血液动力学和氧合作用。如果怀疑存在心脏功能障碍，应谨慎监测，尤其是在血压较低的患者中，随后给予β受体阻滞剂治疗。
