血管加压素对肝硬化患者食管静脉曲张血流的影响：与对门静脉和肠系膜上动脉血流的影响比较

Effect of vasopressin on esophageal varices blood flow in patients with cirrhosis: comparisons with the effects on portal vein and superior mesenteric artery blood flow.

作者信息

Iwao T, Toyonaga A, Oho K, Shigemori H, Sakai T, Tayama C, Masumoto H, Sato M, Tanikawa K

机构信息

Department of Medicine II, Kurume University School of Medicine, Japan.

出版信息

J Hepatol. 1996 Oct;25(4):491-7. doi: 10.1016/s0168-8278(96)80208-x.

DOI:10.1016/s0168-8278(96)80208-x

PMID:8912148

Abstract

BACKGROUND/AIMS: Vasopressin reduces portal pressure which may be due to decreased portal inflow. However, it remains unclear whether vasopressin is able to selectively reduce esophageal varices blood flow. The aim of this study was to address this question.

METHODS

Fifteen patients with cirrhosis and esophageal varices were included in this prospective study. Portal vein and superior mesenteric artery flow velocity were measured with a percutaneous echo-Doppler. Esophageal varices flow velocity was measured using a transesophageal echo-Doppler technique. Mean arterial pressure and heart rate were also recorded. These measurements were performed at baseline condition and 15 min after observer blind drug administration. In this study, two groups, six patients receiving placebo and nine patients receiving 0.3 U/min of vasopressin, were randomized according to the coded number.

RESULTS

Placebo administration had no effect on systemic and splanchnic circulation. In contrast, vasopressin administration increased mean arterial pressure (p < 0.05) associated with a bradycardia (p < 0.01). In splanchnic circulation, vasopressin decreased portal vein (-32 +/- 3%, p < 0.01), superior mesenteric artery (-30 +/- 2%, p < 0.01), and esophageal varices flow velocity (-48 +/- 5%, p < 0.01). When the magnitude of these reductions was compared, ANOVA showed a significant difference (p < 0.01). Furthermore, the reduction in esophageal varices flow velocity was significantly higher than that in portal vein flow velocity (p < 0.01) and that in superior mesenteric artery flow velocity (p < 0.01).

CONCLUSIONS

These data support the view that vasopressin is able to selectively reduce esophageal varices blood flow. This effect, in addition to its well-established portal pressure reducing action, may play a role in its therapeutic efficacy in the treatment of variceal bleeding.

摘要

背景/目的：血管加压素可降低门静脉压力，这可能是由于门静脉血流减少所致。然而，血管加压素是否能够选择性地减少食管静脉曲张血流仍不清楚。本研究的目的是解决这个问题。

方法

本前瞻性研究纳入了15例肝硬化合并食管静脉曲张患者。采用经皮超声多普勒测量门静脉和肠系膜上动脉血流速度。使用经食管超声多普勒技术测量食管静脉曲张血流速度。同时记录平均动脉压和心率。这些测量在基线状态和观察者盲法给药15分钟后进行。在本研究中，根据编码数字将两组患者随机分组，一组6例接受安慰剂，另一组9例接受0.3 U/min的血管加压素。

结果

给予安慰剂对全身和内脏循环无影响。相比之下，给予血管加压素可使平均动脉压升高（p < 0.05），并伴有心动过缓（p < 0.01）。在内脏循环中，血管加压素可使门静脉血流速度降低（-32 +/- 3%，p < 0.01）、肠系膜上动脉血流速度降低（-30 +/- 2%，p < 0.01）以及食管静脉曲张血流速度降低（-48 +/- 5%，p < 0.01）。当比较这些降低幅度时，方差分析显示存在显著差异（p < 0.01）。此外，食管静脉曲张血流速度的降低显著高于门静脉血流速度的降低（p < 0.01）和肠系膜上动脉血流速度的降低（p < 0.01）。