双剂量奥曲肽对肝硬化门脉高压症断流术后患者血流动力学的影响

Effects of two different dosages of octreotide on portal pressure and hepatic hemodynamics in cirrhotic portal hypertensive patients after portal-azygous devascularization and splenectomy

目的研究双剂量奥曲肽对肝硬化门脉高压症断流术后患者门脉压力、肝脏血流动力学影响。方法肝硬化门脉高压症断流术患者26例,随机分两组,术后24 h 开始用奥曲肽。A 组12例,奥曲肽50μg/h;B 组14例,奥曲肽25μg/h;胃网膜右静脉插管至门静脉主干,动态测定门脉压力;彩色超声多普勒测定门脉直径(PV)、门脉最大血流速度(PFV_(max))、门脉平均血流速度(PFV_(mean))、肝动脉最大血流速度(HAV_(max))、肝动脉最小血流速度(HAV_(min));计算门脉血流量参数(PFI)、肝动脉血流量参数(HAFI)。结果断流术后,两组患者门脉压力平均降幅15.4%,PFI 降低(P<0.05);HAV_(max)、HAV_(min)、HAFI 增加(P<0.05)。用奥曲肽72 h 后,两组 PFI、PFV_(max)、PFV_(mean)降低(P<0.05);用药5 min 门脉压力降低,24 h 达高峰,门脉压力平均降幅20.6%。A 组停药后48 h 内,门脉压力未见回升,平均降幅23.1%;B 组停药后2 h 门脉压力有回升趋势,平均降幅11.6%;停药后24 h、48 h两组患者门脉压力比较差异有统计学意义(P<0.01)。Logistic 分析发现,PV、PFV_(max)、PFV_(mean)、HAV_(max)、HAV_(min)与门脉压力无独立相关性。结论肝硬化门脉高压症患者行断流术后,门脉压力降低。双剂量奥曲肽均能明显降低门脉压力;停药后48 h 内,奥曲肽50μg/h 组门脉压力未见回升。提示,临床用奥曲肽50μg/h 对防止静脉曲张再出血更合理。

Objective Increased portal inflow and intrahepatic resistance may play a part of the role in pathogenesis of portal hypertension in cirrhotic patients. Some vasoactive substances may play an important role in the regulation of hepatic hemodynamics. The aim of this study is to investigate the effects of two different dosages of octreotide on portal pressure and hepatic hemedynamics. Methods 26 cirrhotic patients who underwent portal-azygous devascularization and splenectomy were investigated in a randomized and double-blind study. Patients were assigned to receive treatment either with a bolus of octreotide 100 μg, followed by infusion of 50 μg/h for 72 h （ Group A, n = 12） or with a bolus of octreotide 100 μg,followed by infusion of 25 μg/h for 72 h （ Group B, n = 14）. The portal pressure was dynamicaly measured via a catheter placed in portal vein. The indexes of hepatic hemodynamics, including maximal and mean velocity of portal vein flow（ PFVmax, PFVmean ）, maximal and minimal velocity of hepatic artery flow （HAVmax, HAVmin ） were measured using colour sonagraphy at baseline, 72 h after infusion octreotide and 7 days after cessation of the infusion. Results The portal pressure declined 15.4% on aveage either in group A or group B after surgery. Portal pressure was significantly decreased after infusion of octreotide in both group A and B as compared with that at baseline. The mean decrease of portal pressure was 20. 6%. The portal pressure shewed a sustained decrease in group A, but it returned to baseline in group B after stopping of octreotide infusion. The portal pressure in group A and B was statistically different 24 h after stopping octreotide infusion （24. 8 ±6. 5 vs 29.4 ±5.8） ,48 h（25.3 ±6.7 vs 29. 9 ±7.0） ,P 〈0. 05. However, no differences of portal pressure between group A and B before surgery （ 41.0 ± 6. 6 vs 38.5 ± 4. 7 ）, baseline （ 32. 8 ± 4. 9 vs 33.6 ± 6. 5 ） and during octreotide infusion were observed. PFVmax and PFVmean were significantly decreased as compared with baseline either before surgery or octreotide infusion. However, HAVmax and HAVmin were significantly increased as compared with baseline and before surgery. No relationship between portal pressure and sonography indexes was observed. Conclusions Both dosages of octreotide infusion 50 μg/h and 25 μg/h can significantly reduce portal pressure, although with 25 μg/h of octrotide is reflects it seen returned to baseline. The dosage 50 μg/h of octreotide infusion may be more rational for prevention rebleecling of varices in cirrhotic portal hypertensive patients.