Sirinek K R, Adcock D K, Levine B A
Department of Surgery, University of Texas Health Science Center, San Antonio 78284-7842.
Am J Surg. 1989 Jan;157(1):33-7. doi: 10.1016/0002-9610(89)90416-9.
In the present study, 52 patients with cirrhosis, portal hypertension, and variceal hemorrhage underwent either an elective or an emergency side-to-side portacaval shunt operation. Vasopressin was infused intravenously at 60 units/hour from just prior to abdominal incision until completion of the anastomosis. Eight of 35 patients who received vasopressin alone (23 percent) tolerated increased doses of 75 to 90 units/hour to obtain hemostasis. Four of 52 patients required simultaneous infusion of sodium nitroprusside to correct systemic hypertension. An additional 15 percent reduction in portal venous pressure occurred in these patients. Eleven of 13 patients with vasopressin-induced myocardial ischemia responded to simultaneous infusion of nitroglycerin. Further prospective studies are indicated to adequately delineate the dose and duration of therapy with either nitroprusside or nitroglycerin for simultaneous administration with intravenous vasopressin.
在本研究中，52例患有肝硬化、门静脉高压和静脉曲张出血的患者接受了择期或急诊侧侧门腔分流手术。从腹部切口前开始至吻合完成，以60单位/小时的速度静脉输注血管加压素。仅接受血管加压素治疗的35例患者中有8例（23%）耐受增加至75至90单位/小时的剂量以实现止血。52例患者中有4例需要同时输注硝普钠以纠正全身性高血压。这些患者的门静脉压力又额外降低了15%。13例因血管加压素诱发心肌缺血的患者中有11例对同时输注硝酸甘油有反应。需要进一步进行前瞻性研究，以充分确定硝普钠或硝酸甘油与静脉注射血管加压素同时给药时的治疗剂量和持续时间。
