Gatta A, Bolognesi M, Sacerdoti D, Merkel C
Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Padova.
Ann Ital Med Int. 1996 Oct;11 Suppl 2:39S-47S.
The in-depth study of the pathophysiology of portal hypertension is the basis for a correct medical treatment. The backward-flow theory of portal hypertension stresses the importance of increased hepatic vascular resistance, while the forward-flow theory of portal hypertension underscores generalized vasodilation, the hyperdynamic circulation and increased portal inflow. The role of expanded plasma volume has been emphasized in recent studies. The aim of drug therapy is to normalize each one of these components. Vasoconstrictor agents, i.e. vasopressin, triglycyl-lysin-vasopressin, non selective beta-blockers, somatostatin and octreotide, try to normalize the increased portal inflow and to decrease porto-collateral blood flow. Venous vasodilators, e.g. nitrates, mainly act by decreasing portal blood outflow resistance. Spironolactone has been proposed to decrease plasma volume. The use of a combination of a vasoconstrictor agent and a vasodilator or spironolactone has been proposed to increase the efficacy of medical treatment.
深入研究门静脉高压的病理生理学是正确进行药物治疗的基础。门静脉高压的逆流学说强调肝血管阻力增加的重要性，而门静脉高压的顺流学说则强调全身血管舒张、高动力循环和门静脉血流增加。近期研究强调了血浆容量扩张的作用。药物治疗的目的是使这些因素中的每一个都恢复正常。血管收缩剂，即加压素、三甘氨酰赖氨酸加压素、非选择性β受体阻滞剂、生长抑素和奥曲肽，试图使增加的门静脉血流正常化并减少门体侧支血流。静脉血管扩张剂，如硝酸盐类，主要通过降低门静脉血液流出阻力起作用。已提出使用螺内酯来减少血浆容量。有人提出联合使用血管收缩剂和血管扩张剂或螺内酯以提高药物治疗的疗效。
