Pugliese D, Lee S S, Koshy A, Cerini R, Ozier Y, Lebrec D
Unité de Recherches de Physiopathologie Hépatique, INSERM U-24, Hôpital Beaujon, Clichy, France.
Hepatology. 1988 May-Jun;8(3):643-6. doi: 10.1002/hep.1840080334.
In animals, there may exist a hyperemic response in the portal circulation during intravenous administration of hypertonic glucose, but a hemodynamic response of this kind has never been described in man. This study was designed to evaluate if hyperglycemia itself could induce systemic or splanchnic hemodynamic changes in patients with cirrhosis. Sixteen patients with cirrhosis were studied before and during i.v. infusions of hypertonic (900 mOsmoles per liter) glucose (n = 8), mannitol (n = 4) or saline (n = 4) at 2 ml per min. In the group receiving glucose, there were significant increases in hepatic venous pressure gradient (+12%), azygos blood flow (+27%) and pulmonary capillary pressure (+32%), while calf blood flow decreased (-26%). No changes occurred in the mannitol or saline groups. Changes in plasma osmolality, plasma volume, splanchnic oxygen extraction and vasoactive hormones, including vasoactive intestinal polypeptide and glucagon, did not appear to be involved in the mechanism of these vasoactive phenomena. It is suggested that the possible deleterious effects of increase in portal pressure and azygos blood flow should be taken into consideration when administering hypertonic glucose to patients with portal hypertension.
在动物中，静脉注射高渗葡萄糖时门静脉循环可能存在充血反应，但这种血流动力学反应在人类中从未被描述过。本研究旨在评估高血糖本身是否会在肝硬化患者中引起全身或内脏血流动力学变化。对16例肝硬化患者在静脉输注高渗（每升900毫渗量）葡萄糖（n = 8）、甘露醇（n = 4）或生理盐水（n = 4）期间及之前进行了研究，输注速度为每分钟2毫升。在接受葡萄糖的组中，肝静脉压力梯度显著增加（+12%）、奇静脉血流量增加（+27%）和肺毛细血管压力增加（+32%），而小腿血流量减少（-26%）。甘露醇或生理盐水组未发生变化。血浆渗透压、血浆容量、内脏氧摄取以及血管活性激素（包括血管活性肠肽和胰高血糖素）的变化似乎与这些血管活性现象的机制无关。建议在给门静脉高压患者输注高渗葡萄糖时，应考虑门静脉压力和奇静脉血流量增加可能产生的有害影响。
