Bhatia S J, Deshmukh H, Abraham P, Shah A V, Vontivillu J A, Jagasia D H, Kothari R H
Department of Gastroenterology, K E M Hospital, Bombay.
Indian J Gastroenterol. 1990 Apr;9(2):113-5.
Nitrates decrease portal pressure by decreasing portal venous inflow and resistance. We studied over 20 minutes the effect of 10 mg isosorbide dinitrate sublingual on intrasplenic pulp pressure, mean arterial pressure and heart rate, in 13 patients with cirrhotic or non-cirrhotic portal hypertension. The pulp pressure fell progressively over 20 minutes, from mean 43.6 +/- 2.4 (SEM) to 35.6 +/- 1.8 cm H2O (p less than 0.001). This was accompanied initially by a significant fall in mean arterial pressure (85.8 +/- 1.9 to 80.4 +/- 2.7 mmHg at 4 minutes; p less than 0.01) and rise in heart rate (92.5 +/- 5.0 to 102.6 +/- 5.9 per minute at 6 minutes; p less than 0.02), following which these parameters remained stable. One patient developed giddiness due to hypotension at 15 minutes. We conclude that sublingual isosorbide dinitrate decreases pulp pressure in cirrhotic and non-cirrhotic portal hypertensives, but this is initially accompanied by significant hemodynamic changes.
硝酸盐类药物通过减少门静脉血流和阻力来降低门静脉压力。我们对13例肝硬化或非肝硬化门静脉高压患者，研究了舌下含服10毫克二硝酸异山梨酯在20多分钟内对脾内髓质压力、平均动脉压和心率的影响。髓质压力在20分钟内逐渐下降，从平均43.6±2.4（标准误）降至35.6±1.8厘米水柱（p<0.001）。最初，这伴随着平均动脉压显著下降（4分钟时从85.8±1.9降至80.4±2.7毫米汞柱；p<0.01）和心率上升（6分钟时从92.5±5.0升至102.6±5.9次/分钟；p<0.02），随后这些参数保持稳定。1例患者在15分钟时因低血压出现头晕。我们得出结论，舌下含服二硝酸异山梨酯可降低肝硬化和非肝硬化门静脉高压患者的髓质压力，但最初会伴有显著的血流动力学变化。
