Lebrec D
Laboratoire d'Hémodynamique Splanchnique, Unité de Recherches de Physiopathologie Hépatique (INSERM U-24), Clichy, France.
Pharmacol Ther. 1994;61(1-2):65-107. doi: 10.1016/0163-7258(94)90059-0.
In the past 10 years, it has been clearly shown that vasoactive substances reduce portal pressure in patients or animals with portal hypertension. Some of these substances act by inducing splanchnic vasoconstriction, while others reduce hepatic and porto-systemic collateral vascular resistance and, thus, induce a portal hypotensive effect. Still others induce arterial hypotension, which causes a vasoconstrictive effect in the splanchnic territory. Since these drugs act on different vascular receptors, their combination should have a more marked effect on portal hypertension. Up to now, only nonselective beta-blockers have been used in the prevention of first gastrointestinal bleeding in patients with portal hypertension and esophageal varices and in the prevention of recurrent gastrointestinal bleeding. These trials have shown that propranolol or nadolol significantly reduce either a first episode of bleeding or recurrent bleeding. This pharmacological treatment also improves the survival rate in these patients. All of these studies have helped us to understand, in part, why gastrointestinal hemorrhage occurs in certain patients. Additional studies of beta-blockers or other substances are, nevertheless, necessary to select patients who will respond to this type of treatment. Finally, it is possible that the pharmacological treatment of portal hypertension may also be used before esophageal varices occur.
在过去10年中，已经清楚地表明，血管活性物质可降低门静脉高压患者或动物的门静脉压力。其中一些物质通过诱导内脏血管收缩起作用，而其他物质则降低肝内和门体侧支血管阻力，从而产生门静脉降压作用。还有一些物质可导致动脉低血压，进而在内脏区域产生血管收缩作用。由于这些药物作用于不同的血管受体，它们的联合应用对门静脉高压应具有更显著的效果。到目前为止，仅非选择性β受体阻滞剂被用于预防门静脉高压和食管静脉曲张患者的首次胃肠道出血以及预防复发性胃肠道出血。这些试验表明，普萘洛尔或纳多洛尔可显著减少首次出血发作或复发性出血。这种药物治疗还可提高这些患者的生存率。所有这些研究在一定程度上帮助我们理解了某些患者发生胃肠道出血的原因。然而，仍有必要对β受体阻滞剂或其他物质进行更多研究，以筛选出对这类治疗有反应的患者。最后，门静脉高压的药物治疗也有可能在食管静脉曲张出现之前就被应用。
