School of Medicine, Nanjing University, Nanjing, China.
J Gastroenterol Hepatol. 2013 Jul;28(7):1242-6. doi: 10.1111/jgh.12195.
The hemodynamics of patients with portal hypertension within 4 h after a single injection of terlipressin has been studied. However, the hemodynamics in a longer phase under different infusion styles is unknown. This study aims to compare the effects of bolus and continuous infusion of terlipressin on systemic and hepatic hemodynamics in patients with portal hypertension.
Twenty patients who underwent transjugular intrahepatic portosystemic shunt procedure were randomly assigned to be treated with either intravenous bolus infusion of terlipressin (1 mg) followed by a continuous infusion (4 mg/24 h, n = 10), or intravenous bolus injection of terlipressin (2 mg) followed by intermittent injections (1 mg/6 h, n = 10). The mean arterial pressure, heart rate, and portal venous pressure (PVP) were monitored and recorded at baseline, 1 min, 5 min, 10 min, 30 min, and then once an hour. Serum renin activity, serum angiotensin II, and aldosterone levels were measured prior to and 24 h after the administration of terlipressin.
PVP dropped rapidly in both groups, and reduced 16.46% and 28.22%, respectively, at the 1-h time point. Thereafter, PVP remained stable in continuous group while rebounded obviously in intermittent group. One hour after the start of drug administration, heart rate decreased significantly in both groups (84.1 ± 12.8 vs 73.8 ± 12.6 in intermittent group and 86.7 ± 11.5 vs 77.1 ± 13.6 in continuous group, P < 0.005), and mean arterial pressure increased in both groups, although no statistical differences were found.
Continuous infusion of terlipressin reduces PVP stably and may become an alternative to traditional bolus injection.
已有研究观察了特利加压素单次注射后 4 小时内门静脉高压患者的血液动力学变化，但不同输注方式下更长期的血液动力学变化尚不清楚。本研究旨在比较特利加压素持续输注与推注给药对门静脉高压患者全身和肝内血液动力学的影响。
20 例行经颈静脉肝内门体分流术的患者被随机分为两组，分别接受特利加压素持续静脉滴注（1mg，然后以 4mg/24h 的速度持续输注，n=10）或特利加压素持续静脉推注（2mg，然后以 1mg/6h 的速度间歇性推注，n=10）。在基线、1 分钟、5 分钟、10 分钟、30 分钟以及此后每小时监测并记录平均动脉压、心率和门静脉压力（PVP）。在特利加压素给药前和给药后 24 小时测量血清肾素活性、血管紧张素 II 和醛固酮水平。
两组患者的 PVP 均迅速下降，在 1 小时时分别下降了 16.46%和 28.22%。此后，持续组的 PVP 保持稳定，而间歇组则明显反弹。药物给药开始后 1 小时，两组患者的心率均明显下降（间歇组 84.1±12.8 比 73.8±12.6，持续组 86.7±11.5 比 77.1±13.6，P<0.005），两组患者的平均动脉压均升高，但无统计学差异。
特利加压素持续输注可稳定降低 PVP，可能成为传统推注给药的替代方案。
