Zoli M, Magalotti D, Ghigi G, Marchesini G, Pisi E
Instituto di Clinica Medica Generale e Terapía Medica, University of Bologna, Italy.
J Hepatol. 1996 Oct;25(4):498-503. doi: 10.1016/s0168-8278(96)80209-1.
BACKGROUND/AIMS: The present study was aimed to evaluate the 24-hour effect of transdermal nitroglycerin on splanchnic hemodynamics in cirrhotic patients.
Hemodynamic parameters (blood velocity and resistance indexes) were determined by means of pulsed echo-Doppler, a non-invasive method which proved to be useful to evaluate the effects of drugs on splanchnic vessels. Nine patients with biopsy-proven liver cirrhosis were studied. They were kept on a standard diet divided into 3 meals served at 8, 12 a.m. and 6 p.m. Echo-Doppler measurements were determined for 2 consecutive days at 7, 8, 9, 12 a.m, 1, 3, 6, 7, 9, 12 p.m. and again at 7 a.m. A transdermal nitroglycerin tape, capable of releasing 15 mg of the drug in 24 h, was applied to the skin of the chest at 7 a.m. of the second day.
After nitroglycerin mean portal blood velocity and flow significantly decreased by 18 and 22%. Similarly superior mesenteric artery velocity decreased, while resistance indexes increased. ANOVA analysis showed a significant effect of the drug on superior mesenteric artery and portal flow, while the effect on hepatic artery flow and renal indexes were low.
This study shows that nitroglycerin, given as transdermal long-acting system, significantly influences portal hemodynamics in liver cirrhosis. Its use, favoured by easy administration, may be proposed for long-term clinical studies to test its efficacy in preventing gastrointestinal bleeding.
背景/目的：本研究旨在评估经皮硝酸甘油对肝硬化患者内脏血流动力学的24小时影响。
采用脉冲回声多普勒测定血流动力学参数（血流速度和阻力指数），这是一种无创方法，已被证明可用于评估药物对内脏血管的影响。研究了9例经活检证实为肝硬化的患者。他们维持标准饮食，分三餐，分别于上午8点、12点和下午6点供应。连续两天在上午7点、8点、9点、12点、下午1点、3点、6点、7点、9点、12点以及次日上午7点进行回声多普勒测量。在第二天上午7点，将一片24小时能释放15毫克药物的经皮硝酸甘油贴剂贴于胸部皮肤。
使用硝酸甘油后，平均门静脉血流速度和血流量显著降低18%和22%。同样，肠系膜上动脉血流速度降低，而阻力指数增加。方差分析显示，该药物对肠系膜上动脉和门静脉血流有显著影响，而对肝动脉血流和肾指数的影响较小。
本研究表明，以经皮长效系统给予硝酸甘油，可显著影响肝硬化患者的门静脉血流动力学。因其给药方便，可用于长期临床研究，以测试其预防胃肠道出血的疗效。
