Forrest E H, Bouchier I A, Hayes P C
Department of Medicine, Royal Infirmary of Edinburgh, UK.
J Hepatol. 1996 Dec;25(6):909-15. doi: 10.1016/s0168-8278(96)80296-0.
BACKGROUND/AIMS: Combinations of beta-blockers and vasodilators have been assessed for their ability to lower portal pressure and so prevent variceal haemorrhage. However, reservations have been raised particularly with respect to renal function and perfusion after the use of these medicines in patients with chronic liver disease. We studied the acute effects of carvedilol, a new vasodilating beta-blocker which combines non-selective beta-blockade with alpha-1 receptor antagonism, upon the haemodynamics of patients with cirrhosis.
Sixteen patients completed the study which measured the changes approximately 1 h after the administration of 25 mg oral carvedilol.
The hepatic venous pressure gradient fell from 16.7 +/- 0.9 to 13.6 +/- 1.0 mmHg (p < 0.00001), accounted for largely by reductions in the wedged hepatic venous pressure. Despite this, the azygos blood flow did not change. There was a significant fall in mean arterial pressure (94.8 +/- 4.4 cf. 84.6 +/- 4.3 mmHg; p = 0.0001), which was particularly apparent in the diastolic blood pressure of those patients with ascites. The heart rate only fell significantly in the ascitic subjects. No significant changes occurred in the cardiac output or systemic vascular resistance. Unilateral renal vein flow as measured by the reverse thermodilution technique remained constant.
Carvedilol is therefore a potent acute portal hypotensive agent which does not appear to compromise renal perfusion. However, patients with ascites are at greater risk of its systemic hypotensive action.
背景/目的：已对β受体阻滞剂和血管扩张剂的联合使用降低门静脉压力从而预防静脉曲张出血的能力进行了评估。然而，在慢性肝病患者中使用这些药物后，尤其是在肾功能和灌注方面存在一些疑虑。我们研究了一种新型血管扩张性β受体阻滞剂卡维地洛（它将非选择性β受体阻滞与α1受体拮抗作用相结合）对肝硬化患者血流动力学的急性影响。
16名患者完成了该研究，该研究在口服25mg卡维地洛后约1小时测量变化情况。
肝静脉压力梯度从16.7±0.9降至13.6±1.0mmHg（p<0.00001），主要是由于楔入肝静脉压力降低所致。尽管如此，奇静脉血流量并未改变。平均动脉压显著下降（94.8±4.4对比84.6±4.3mmHg；p=0.0001），在腹水患者的舒张压中尤为明显。仅腹水患者的心率显著下降。心输出量或全身血管阻力无显著变化。通过反向热稀释技术测量的单侧肾静脉血流量保持恒定。
因此，卡维地洛是一种有效的急性门静脉降压药物，似乎不会损害肾灌注。然而，腹水患者发生全身性低血压作用的风险更高。
