Weinshel E H, Altszuler H M, Raicht R F, Sedlis S P
Department of Medicine, New York VA Medical Center, New York.
Am J Med Sci. 1994 Jun;307(6):396-400. doi: 10.1097/00000441-199406000-00002.
It is unknown whether beta adrenergic stress has adverse hepatic hemodynamic effects. Therefore, the authors studied the hemodynamic effects of beta adrenergic stimulation and subsequent blockade in 10 patients with cirrhosis (6 Childs A, 3 Childs B, and 1 Childs C) with known or suspected portal hypertension. Free and wedged hepatic vein pressures, hepatic venous pressure gradient, heart rate, mean arterial pressure, cardiac output, and azygos vein blood flow were measured at rest and after isoproterenol infusion (mean dose = 7.3 micrograms/min: target heart rate = 150% to 200% of resting heart rate). Esmolol, an ultra-short-acting beta blocker, was then infused (dose titrated to return heart rate to baseline), and all measurements were repeated. Based on the results, the authors conclude that beta adrenergic stress provoked by isoproterenol infusion significantly increases azygos vein blood flow and hepatic venous pressure gradient. Beta blockade with esmolol reduces azygos vein blood flow and hepatic venous pressure gradient significantly below baseline.
β肾上腺素能应激是否具有不良的肝脏血流动力学效应尚不清楚。因此，作者研究了10例已知或疑似门静脉高压的肝硬化患者（6例Childs A级、3例Childs B级和1例Childs C级）β肾上腺素能刺激及随后阻断的血流动力学效应。在静息状态下以及静脉输注异丙肾上腺素后（平均剂量=7.3微克/分钟：目标心率为静息心率的150%至200%），测量自由肝静脉压、楔压肝静脉压、肝静脉压力梯度、心率、平均动脉压、心输出量和奇静脉血流量。然后输注超短效β受体阻滞剂艾司洛尔（剂量滴定以使心率恢复至基线），并重复所有测量。基于这些结果，作者得出结论，静脉输注异丙肾上腺素引发的β肾上腺素能应激显著增加奇静脉血流量和肝静脉压力梯度。使用艾司洛尔进行β受体阻断可使奇静脉血流量和肝静脉压力梯度显著降低至基线以下。
