Matsutani S, Mizumoto H, Fukuzawa T, Ohto M, Okuda K
First Department of Medicine, Chiba University, School of Medicine, Japan.
J Hepatol. 1995 Nov;23(5):557-62. doi: 10.1016/0168-8278(95)80062-x.
BACKGROUND/AIMS: A problem in pharmacotherapy for bleeding varices in portal hypertension is non-responders. The aim of this study was to elucidate the features of hemodynamic response to vasopressin in the gastroesophageal collateral vein in patients with esophageal varices.
Flow velocity in the portal and the collateral left gastric vein was measured with an echo-Doppler flowmeter before and during infusion of vasopressin, 0.2 U/min, in 41 patients with cirrhosis and esophageal varices.
The decrease in flow velocity in the left gastric vein with vasopressin (-29 +/- 25%) was significantly smaller than that in the portal vein (-56 +/- 20%). There was no or only minimal change in flow velocity in the left gastric vein in 39% of the patients, especially in those with large-size varices. In 28 patients examined by portal catheterization, changes in flow velocity in the left gastric vein were correlated with portal pressure, and portal pressure in non-responders was significantly higher than that in responders (non-responders: 363 +/- 49, responders: 312 +/- 41 mmH2O, p < 0.05).
It was concluded that hepatofugal blood flow in the gastroesophageal collateral is not readily reduced by vasopressin. However, as the study was performed in a stable condition without variceal bleeding, whether these hemodynamic features will apply during acute variceal bleeding in patients who are known to have a poor hemodynamic response to vasopressin remains to be elucidated.
背景/目的：门脉高压症静脉曲张出血药物治疗中的一个问题是存在无反应者。本研究的目的是阐明食管静脉曲张患者胃食管侧支静脉对血管加压素血流动力学反应的特征。
在41例肝硬化和食管静脉曲张患者中，于输注血管加压素（0.2 U/min）前及输注过程中，用超声多普勒流量计测量门静脉和胃左静脉侧支的血流速度。
血管加压素使胃左静脉血流速度下降（-29±25%），明显小于门静脉（-56±20%）。39%的患者胃左静脉血流速度无变化或仅有极小变化，尤其是那些有大尺寸静脉曲张的患者。在28例行门静脉插管检查的患者中，胃左静脉血流速度变化与门静脉压力相关，无反应者的门静脉压力明显高于有反应者（无反应者：363±49，有反应者：312±41 mmHg，p<0.05）。
得出的结论是，血管加压素不易降低胃食管侧支的离肝血流。然而，由于本研究是在无静脉曲张出血的稳定状态下进行的，对于已知对血管加压素血流动力学反应不佳的患者，这些血流动力学特征在急性静脉曲张出血时是否适用仍有待阐明。
