Vinel J P, Monnin J L, Combis J M, Calés P, Desmorat H, Pascal J P
Service d'Hépato Gastroentérologie, C.H.U. Purpan, Toulouse, France.
Hepatology. 1990 Feb;11(2):239-42. doi: 10.1002/hep.1840110213.
Organic nitrates were reported to reduce portohepatic venous pressure gradient in patients with cirrhosis. However, these drugs lower arterial pressure and are well known to induce tolerance. The aim of the present study was to assess the hemodynamic effects of molsidomine, an antianginal agent, which does not induce tolerance and has little effect on arterial pressure in patients with normal liver, in 13 patients with alcoholic cirrhosis. Wedged hepatic vein pressure (-11%, p less than 0.01), portohepatic venous pressure gradient (-15%, p less than 0.005), hepatic blood flow (-17.4%, p less than 0.005), mean arterial pressure (-13.5%, p less than 0.01) and cardiac output (-17%, p less than 0.001) were significantly reduced by molsidomine. Free hepatic vein pressure, intrinsic hepatic clearance indocyanine green, heart rate and systemic vascular resistances were not significantly modified. There was no correlation between the decrease in portohepatic venous pressure gradient and the reduction in mean arterial pressure on one hand and the decrease in cardiac output on the other hand. We therefore conclude that in patients with cirrhosis, molsidomine has effects similar to nitrates on systemic and splanchnic hemodynamics.
据报道，有机硝酸盐可降低肝硬化患者的肝门静脉压力梯度。然而，这些药物会降低动脉压，且众所周知会产生耐受性。本研究的目的是评估抗心绞痛药物吗多明对13例酒精性肝硬化患者的血流动力学影响，吗多明在肝功能正常的患者中不会产生耐受性，且对动脉压影响较小。吗多明使肝静脉楔压（降低11%，p<0.01）、肝门静脉压力梯度（降低15%，p<0.005）、肝血流量（降低17.4%，p<0.005）、平均动脉压（降低13.5%，p<0.01）和心输出量（降低17%，p<0.001）显著降低。游离肝静脉压、肝内吲哚菁绿固有清除率、心率和全身血管阻力无显著改变。一方面，肝门静脉压力梯度的降低与平均动脉压的降低之间，另一方面与心输出量的降低之间均无相关性。因此，我们得出结论，在肝硬化患者中，吗多明对全身和内脏血流动力学的影响与硝酸盐类似。
