Sarin S K, Saraya A
Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
Am J Gastroenterol. 1995 Jan;90(1):48-53.
Effective and safe reduction of variceal pressure by pharmacological means.
Twenty patients with portal hypertension and large esophageal varices. Ten patients received i.v. nitroglycerin (300 micrograms-bolus) and an equal number received a combination of i.v. nitroglycerin (150 micrograms) and metoclopramide (20-mg bolus). Continuous measurement of variceal pressure and systemic hemodynamics was carried out.
Compared with the baseline, the variceal pressure was reduced at 10 min after injection of 300 micrograms nitroglycerin (22.3 +/- 7.9 vs. 17.3 +/- 7 mm Hg, p, not significant); the percentage reduction was 23.5 +/- 15.8%. With the combination of low dose (150 micrograms) nitroglycerin and metoclopramide, variceal pressure significantly decreased from 23.1 +/- 4.7 to 15.9 +/- 5.9 mm Hg (p < 0.01) (a reduction of 29.5 +/- 24.1%). There was no significant alteration in the heart rate or mean arterial pressure with either regimen.
Our results suggest that a combination of i.v. metoclopramide and low-dose nitroglycerin reduces variceal pressure more effectively than high-dose nitroglycerin used alone. This combination should be further evaluated in the control of acute variceal bleeding.
通过药物手段有效且安全地降低静脉曲张压力。
20例门静脉高压和食管大静脉曲张患者。10例患者静脉注射硝酸甘油（300微克推注），另外10例患者接受静脉注射硝酸甘油（150微克）和甲氧氯普胺（20毫克推注）的联合治疗。持续测量静脉曲张压力和全身血流动力学。
与基线相比，注射300微克硝酸甘油后10分钟时静脉曲张压力降低（22.3±7.9对17.3±7毫米汞柱，p无显著性差异）；降低百分比为23.5±15.8%。使用低剂量（150微克）硝酸甘油与甲氧氯普胺联合治疗时，静脉曲张压力从23.1±4.7显著降至15.9±5.9毫米汞柱（p<0.01）（降低29.5±24.1%）。两种治疗方案的心率或平均动脉压均无显著改变。
我们的结果表明，静脉注射甲氧氯普胺和低剂量硝酸甘油联合治疗比单独使用高剂量硝酸甘油更有效地降低静脉曲张压力。这种联合治疗在急性静脉曲张出血的控制中应进一步评估。
