Mastai R, Bosch J, Bruix J, Navasa M, Kravetz D, Rodés J
Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain.
Hepatology. 1989 Sep;10(3):269-72. doi: 10.1002/hep.1840100302.
In patients with cirrhosis and portal hypertension, propranolol administration reduces heart rate and cardiac output and diminishes portal pressure and collateral blood flow. However, there is little information on the possible effects of propranolol on hepatic artery blood flow. The present study addressed this question in 12 cirrhotic patients with end-to-side portacaval shunt, in whom all of the liver blood flow represents the hepatic artery blood flow. Hepatic artery blood flow (continuous infusion of indocyanine green), cardiac output (thermal dilution), heart rate and mean arterial pressure were measured before and 20 min after the intravenous infusion of 10 to 15 mg of propranolol. beta-Adrenergic blockade caused a significant reduction of cardiac output (from 9.1 +/- 2.1 to 7.1 +/- 1.4 liters per min, p less than 0.001) (mean +/- S.D.) and heart rate (from 85 +/- 10 to 71 +/- 7 beats per min, p less than 0.001), and a significant increase of systemic vascular resistance (from 9.0 +/- 2.1 to 11.7 +/- 2.7 mmHg per liter per min, p less than 0.001), whereas mean arterial pressure did not change (77 vs. 78 mmHg). Propranolol significantly reduced hepatic artery blood flow (from 0.65 +/- 0.20 to 0.55 +/- 0.14 liters per min, p less than 0.01). However, reduction of hepatic artery blood flow (-12.9 +/- 7.3%) was significantly less than reduction of cardiac output (-21.1 +/- 5.2%, p less than 0.01). As a result, the fraction of the cardiac output delivered to the liver was significantly greater after propranolol (8.0 +/- 1.7%) than before (7.3 +/- 1.7%, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
在肝硬化和门静脉高压患者中，使用普萘洛尔可降低心率和心输出量，并降低门静脉压力和侧支血流。然而，关于普萘洛尔对肝动脉血流可能产生的影响，相关信息较少。本研究针对12例接受端侧门腔分流术的肝硬化患者探讨了这一问题，在这些患者中，所有肝脏血流均代表肝动脉血流。在静脉输注10至15毫克普萘洛尔之前和之后20分钟，测量肝动脉血流（连续输注吲哚菁绿）、心输出量（热稀释法）、心率和平均动脉压。β受体阻滞剂导致心输出量显著降低（从9.1±2.1升/分钟降至7.1±1.4升/分钟，p<0.001）（平均值±标准差），心率降低（从85±10次/分钟降至71±7次/分钟，p<0.001），全身血管阻力显著增加（从9.0±2.1毫米汞柱/升/分钟增至11.7±2.7毫米汞柱/升/分钟，p<0.001），而平均动脉压未改变（77毫米汞柱对78毫米汞柱）。普萘洛尔显著降低肝动脉血流（从0.65±0.20升/分钟降至0.55±0.14升/分钟，p<0.01）。然而，肝动脉血流的降低幅度（-12.9±7.3%）显著小于心输出量的降低幅度（-21.1±5.2%，p<0.01）。结果，普萘洛尔治疗后输送至肝脏的心输出量比例（8.0±1.7%）显著高于治疗前（7.3±1.7%，p<0.05）。（摘要截断于250字）
