Lautt W W
Circ Res. 1977 Dec;41(6):787-90. doi: 10.1161/01.res.41.6.787.
Raising the hepatic venous pressure experimentally duplicates the type of hepatic congestion seen in many clinical situations including congestive heart failure. Venous pressure was controlled using a hepatic venous long circuit preparation and was raised by 6 cm blood (4.7 mm Hg) or 10 cm (7.8 mm Hg). Total splanchnic blood flow and oxygen uptake were reduced by these maneuvers but hepatic arterial flow was not altered nor was hepatic oxygen uptake. Blood flow in the portal vein decreased to 65 +/- 12% of control and gut oxygen uptake decreased to 60 +/- 14% of control. The data confirm that raised hepatic venous pressure does not produce hepatic edema in spite of massive prolonged fluid filtration across the liver into the peritoneum. In spite of a reduced (to 84 +/- 3% of control) hepatic oxygen delivery, the liver can maintain oxygen uptake (99 +/- 7% of control) by increasing oxygen extraction to appropriate levels. The hepatic artery in these cats were capable of myogenic vasoconstriction in response to altered arterial pressure, but in response to raised venous pressure no tendency for constriction was seen. This is in marked contrast to the vasoconstriction seen in isolated perfused livers where portal blood flow is held constant during the raised venous pressure.
通过实验提高肝静脉压力可重现许多临床情况(包括充血性心力衰竭)中所见的肝充血类型。使用肝静脉长回路制备法控制静脉压力,并将其提高6厘米血液柱(4.7毫米汞柱)或10厘米(7.8毫米汞柱)。这些操作使总内脏血流量和氧摄取量减少,但肝动脉血流量未改变,肝氧摄取量也未改变。门静脉血流量降至对照值的65±12%,肠道氧摄取量降至对照值的60±14%。数据证实,尽管大量液体持续从肝脏滤入腹膜,但肝静脉压力升高并不会导致肝水肿。尽管肝氧输送量降低(降至对照值的84±3%),但肝脏可通过将氧摄取率提高到适当水平来维持氧摄取(为对照值的99±7%)。这些猫的肝动脉能够对动脉压力变化产生肌源性血管收缩,但对静脉压力升高无收缩倾向。这与在离体灌注肝脏中所见的血管收缩形成鲜明对比,在离体灌注肝脏中,静脉压力升高时门静脉血流量保持恒定。