Stump D L, Hardin T C
Audie L. Murphy Memorial Veterans' Hospital, San Antonio, Texas.
Drugs. 1990 Jan;39(1):38-53. doi: 10.2165/00003495-199039010-00004.
Vasopressin is a potent vasoconstrictor which greatly reduces mesenteric blood flow. In patients with portal hypertension this results in decreased portal venous flow and portal pressure. Because of this property, vasopressin has been used for years in the therapy of variceal haemorrhage. A few controlled trials show that vasopressin causes a decrease in bleeding but has no effect on survival. It has been shown that intravenous vasopressin is just as effective as intra-arterial, and is associated with fewer complications. The inability to influence the outcome of variceal haemorrhage significantly may be related to suboptimal dosing due to the occurrence of systemic complications at higher doses. The combination of vasopressin with either sodium nitroprusside or nitroglycerin (glyceryl trinitrate) has resulted in a further decline of portal pressure, along with amelioration of most of the adverse haemodynamic effects of vasopressin. Whether or not clinical efficacy is increased when vasopressin is combined with sodium nitroprusside or nitroglycerin remains to be proven. Analogues of vasopressin, such as terlipressin, held early promise as agents which would be as effective as vasopressin, without the cardiac adverse effects. Recent data have not supported this and at present there is little to suggest any advantage of terlipressin over vasopressin. Virtually no adequate studies have yet been performed to support the use of vasopressin in the treatment of non-variceal haemorrhages. There is reason to suspect that vasopressin can effectively control bleeding from haemorrhagic gastritis, but the subsequent results of inducing gastric ischaemia in an already damaged gastric mucosa are unknown. In summary, vasopressin appears to have little effect on the mortality of patients with variceal haemorrhage. It may, however, help control the haemorrhage in some patients by lowering the portal pressure. Cardiovascular complications limit the dose that can be used but it is hoped that by combining vasopressin with nitroglycerin, a more effective and safe therapy will be available for variceal haemorrhages.
血管加压素是一种强效血管收缩剂，可显著减少肠系膜血流。在门静脉高压患者中，这会导致门静脉血流和门静脉压力降低。由于这一特性，血管加压素多年来一直用于治疗静脉曲张出血。一些对照试验表明，血管加压素可减少出血，但对生存率无影响。已表明静脉注射血管加压素与动脉内注射效果相同，且并发症较少。由于高剂量时会出现全身并发症，导致给药剂量不理想，因此无法显著影响静脉曲张出血的结局。血管加压素与硝普钠或硝酸甘油联合使用，可使门静脉压力进一步降低，同时改善血管加压素的大多数不良血流动力学效应。血管加压素与硝普钠或硝酸甘油联合使用时临床疗效是否提高仍有待证实。血管加压素类似物，如特利加压素，早期有望成为与血管加压素效果相同但无心脏不良反应的药物。最近的数据并不支持这一点，目前几乎没有证据表明特利加压素比血管加压素有任何优势。实际上，尚未进行充分的研究来支持血管加压素用于治疗非静脉曲张出血。有理由怀疑血管加压素可有效控制出血性胃炎的出血，但在已经受损的胃黏膜中诱发胃缺血的后续结果尚不清楚。总之，血管加压素似乎对静脉曲张出血患者的死亡率影响不大。然而，它可能通过降低门静脉压力帮助控制一些患者的出血。心血管并发症限制了可使用的剂量，但希望通过将血管加压素与硝酸甘油联合使用，能为静脉曲张出血提供更有效和安全的治疗方法。
