Møller S, Brinch K, Henriksen J H, Becker U
Department of Clinical Physiology, Hvidovre Hospital, University of Copenhagen, Denmark.
J Hepatol. 1997 May;26(5):1026-33. doi: 10.1016/s0168-8278(97)80111-0.
BACKGROUND/AIMS: Cirrhosis with portal hypertension is associated with changes in the splanchnic and systemic haemodynamics, and subsequent complications, such as bleeding from oesophageal varices, have led to the introduction of long-acting somatostatin analogues in the treatment of portal hypertension. However, reports on the splanchnic and systemic effects of octreotide are contradictory and therefore the aim of the present study was to assess the effects of continuous infusion of octreotide on central and systemic haemodynamics, portal pressures, and hepatic blood flow.
Thirteen patients with cirrhosis underwent liver vein catheterisation. Portal and arterial blood pressures were determined at baseline and 10, 30, and 50 min after a bolus injection of octreotide 100 micrograms, followed by continuous infusion of octreotide 100 micrograms/ h for 1 h. Hepatic blood flow, cardiac output, central and arterial blood volume, and central circulation time were determined at baseline and 50 min after the start of the octreotide infusion.
The mean arterial blood pressure increased during the first 10 min (p < 0.0005), but returned to baseline after 50 min. The central and arterial blood volume (-16%, p < 0.005) and the central circulation time (-8%, p < 0.05) were significantly decreased after 50 min, whereas the cardiac output did not change significantly. The hepatic venous pressure gradient and the hepatic blood flow did not change significantly at any time after infusion of octreotide.
Octreotide does not affect the portal pressure or hepatic blood flow, whereas it may further contract the central blood volume and thereby exert a potentially harmful effect on central hypovolaemia in patients with cirrhosis. However, these early effects do not exclude the possibility that administration of longacting somatostatin analogues over a longer period may have a beneficial effect.
背景/目的：肝硬化伴门静脉高压与内脏和全身血流动力学变化相关，随后出现的并发症，如食管静脉曲张出血，促使长效生长抑素类似物被用于门静脉高压的治疗。然而，关于奥曲肽对内脏和全身影响的报道相互矛盾，因此本研究的目的是评估持续输注奥曲肽对中心和全身血流动力学、门静脉压力及肝血流量的影响。
13例肝硬化患者接受肝静脉插管。在静脉推注100微克奥曲肽前及推注后10、30和50分钟测定门静脉和动脉血压，随后持续输注100微克/小时奥曲肽1小时。在奥曲肽输注开始前及输注50分钟后测定肝血流量、心输出量、中心和动脉血容量以及中心循环时间。
平均动脉血压在最初10分钟内升高（p<0.0005），但50分钟后恢复至基线水平。50分钟后，中心和动脉血容量（-16%，p<0.005）及中心循环时间（-8%，p<0.05）显著降低，而心输出量无明显变化。输注奥曲肽后任何时间，肝静脉压力梯度和肝血流量均无明显变化。
奥曲肽不影响门静脉压力或肝血流量，但可能进一步使中心血容量收缩，从而对肝硬化患者的中心低血容量产生潜在有害影响。然而，这些早期影响并不排除长期使用长效生长抑素类似物可能产生有益作用的可能性。
