Sekiyama T, Komeichi H, Nagano T, Ohsuga M, Terada H, Katsuta Y, Satomura K, Aramaki T
First Department of Internal Medicine, Nippon Medical School, Tokyo, Japan.
Arzneimittelforschung. 1997 Apr;47(4):353-5.
To enhance the portal hypotensive effect of nonselective beta-blockers, combinations of vasoactive agents with different mechanisms should be considered. The effect of carvedilol (CAS 72956-09-3, Artist), and alpha-/beta-blocking agent, on hepatic and systemic hemodynamics in 10 patients with portal hypertension was evaluated. After administration of carvedilol, the hepatic venous pressure gradient (HVPG) decreased from 15.9 +/- 3.2 mmHg to 13.3 +/- 4.0 mmHg (mean +/- SD) at 60 min (-15%) and to 12.9 +/- 3.0 mmHg at 90 min (-17%, p < 0.05). However, only 5 patients showed a decrease of HVPG by more than 20% at 60 or 90 min. The estimated hepatic blood flow (EHBF) was not significantly reduced. In contrast, heart rate (-8%, p < 0.05), mean arterial pressure (-10%, p < 0.01), and cardiac index (CI) (-8%, p < 0.05) were all reduced at 90 min, while total systemic vascular resistance was not altered. The reduction of HVPG was significantly correlated with the decrease of CI (r = 0.6415, p < 0.05). The portal hypotensive effect of carvedilol may mainly result from a reduction of CI. However, because of the greater reduction of HVPG than that of CI, other additive actions were suggested.
为增强非选择性β受体阻滞剂的门脉降压效果，应考虑联合使用具有不同作用机制的血管活性药物。对10例门静脉高压患者，评估了α/β受体阻滞剂卡维地洛（化学物质登记号72956 - 09 - 3，商品名：达利全）对肝脏和全身血流动力学的影响。给予卡维地洛后，肝静脉压力梯度（HVPG）在60分钟时从15.9±3.2 mmHg降至13.3±4.0 mmHg（均值±标准差）（降低15%），在90分钟时降至12.9±3.0 mmHg（降低17%，p<0.05）。然而，仅5例患者在60或90分钟时HVPG降低超过20%。估计肝血流量（EHBF）未显著减少。相比之下，心率（降低8%，p<0.05）、平均动脉压（降低10%，p<0.01）和心脏指数（CI）（降低8%，p<0.05）在90分钟时均降低，而总全身血管阻力未改变。HVPG的降低与CI的降低显著相关（r = 0.6415，p<0.05）。卡维地洛的门脉降压作用可能主要源于CI的降低。然而，由于HVPG的降低幅度大于CI，提示可能存在其他附加作用。
