Siegel J H, Giovannini I, Coleman B, Cerra F B, Nespoli A
Arch Surg. 1981 Oct;116(10):1330-41. doi: 10.1001/archsurg.1981.01380220074012.
Detailed serial cardiovascular and respiratory physiologic studies were carried out in 80 patients with cirrhotic liver disease, including 45 cirrhotic patients who underwent portal decompressive surgery on an urgent or elective basis. In surgical cases, death could be predicted from the first postoperative day's pattern of response. Predictors of death were an increase in percent of pulmonary shunt due to a redistribution of the increased pulmonary blood flow, and a disproportionate fall in vascular tone, which permits an increased cardiac ejection fraction even when significant myocardial depression occurs. The etiology of the vascular tone defect seems related to the rise in levels of the false neurotransmitter octopamine, which are shown to increase as oxygen consumption falls in the patho-physiologic hyperdynamic B state, presumably due to a block in the oxidative metabolism of aromatic amino acids.
对80例肝硬化患者进行了详细的系列心血管和呼吸生理研究，其中45例肝硬化患者接受了急诊或择期门脉减压手术。在手术病例中，术后第一天的反应模式可预测死亡。死亡的预测因素是由于肺血流量增加的重新分布导致肺分流百分比增加，以及血管张力不成比例下降，即使在出现明显心肌抑制时也能使心脏射血分数增加。血管张力缺陷的病因似乎与假神经递质章鱼胺水平升高有关，在病理生理高动力B状态下，随着氧耗量下降，章鱼胺水平升高，这可能是由于芳香族氨基酸氧化代谢受阻所致。
