Merkel C, Finucci G, Zuin R, Bazzerla G, Bolognesi M, Sacerdoti D, Gatta A
J Hepatol. 1987 Apr;4(2):174-80. doi: 10.1016/s0168-8278(87)80077-6.
It has recently been reported that vasodilators lower portal pressure in patients with cirrhosis. This effect, however, is not definitively proven. The effect of isosorbide dinitrate (5 mg sublingually) on splanchnic and systemic hemodynamics was investigated in 13 patients with alcoholic cirrhosis and portal hypertension. The administration of isosorbide dinitrate reduced hepatic venous pressure gradient by 34% (P less than 0.001), mean arterial pressure by 30% (P less than 0.001), cardiac index by 17% (P less than 0.001) and systemic vascular resistance by 11% (P = 0.05). Hepatic blood flow was not affected by the treatment. Significant correlations were found between the decrease in hepatic venous pressure gradient and that of cardiac index (P less than 0.05) and mean arterial pressure (P less than 0.05). These data indicate that isosorbide dinitrate lowers portal pressure in patients with cirrhosis. Decrease in cardiac output, rise in splanchnic arterial vascular resistance and decrease in porto-hepatic resistance seem to participate in determining the effect.
最近有报道称，血管扩张剂可降低肝硬化患者的门静脉压力。然而，这一效果尚未得到确切证实。本研究对13例酒精性肝硬化和门静脉高压患者，调查了舌下含服硝酸异山梨酯（5mg）对内脏和全身血流动力学的影响。服用硝酸异山梨酯后，肝静脉压力梯度降低了34%（P<0.001），平均动脉压降低了30%（P<0.001），心脏指数降低了17%（P<0.001），全身血管阻力降低了11%（P=0.05）。肝血流量不受该治疗的影响。肝静脉压力梯度的降低与心脏指数的降低（P<0.05）和平均动脉压的降低（P<0.05）之间存在显著相关性。这些数据表明，硝酸异山梨酯可降低肝硬化患者的门静脉压力。心输出量降低、内脏动脉血管阻力升高和门静脉-肝阻力降低似乎参与了这一作用的形成。
