硝吡苯啶对慢性肺心病急性发作期肝循环障碍的影响

本文选用慢性肺心病急发期伴呼衰22例,随机分为试验组和对照组。两组常规治疗相同,试验组加服硝苯吡啶(30mg/日,分三次口服,连用两周)。在治疗前、治疗一周及二周分别监测血流动力学及血液流变学变化。结果表明,硝苯吡啶能明显增加肝脏血液灌流,改善肝循环状态。其机制可能为:(1)抑制肝血管收缩,减少血管阻力;(2)降低肺血管阻力,改善右心功能,增加心输出量,从而降低腔静脉压力及肝循环的肝后阻力;(3)减低血液粘滞度及肝内血流阻力。本文还对硝苯吡啶改善慢性肺心病肝循环的临床意义作了初步探讨。

THE EFFECT OF NIFEDIPINE ON LIVER CIRCULATION IN RESPIRATORY FAILURES OF CPR PULMONALE

Twenty-lwo patients ( 16 males and 6 females) with , the respiratory failure of chronic pulmonary heart disease entered into a trial group and a control groupat random with the same treatment. The two-week regime of nifedipine ( 30mg/ day, oral) was given in the trial group. The hemodynamic monitoring of systemic,pulmonary and liver circulation was carried out in all cases with the impedance rheogram, before and, one or two weeks after the treatment; meanwhile, the parameters of the hemorhology, and the blood gas analysis were undertaken.The results showed that , nifedipine increased the liver bipod perfusion obviously, and improved the condition of liver circulation. The mechanisms may be as follows: ( 1 ) Reduction of the pulmonary arterial pressure and improvement of the right ventricular function contribute to the lowering of the pressure of vena cava and the postohepatic resistance; ( 2 ) The lowering of the blood viscosity decreases the blood flow resistance; ( 3 ) The vascular resistance decreases as a result of the inhibition of the hepatic vasoconstriction; (4) The cardiac output is on the increase. These effects are not referable to the improvement of blood gases. This paper suggests that the disturbance of liver circulatio may be presentbefore the abnormal routine tests of liver function in the acute exacerbation ofcor pulmonale. It is believed that nifedipine can protect liver cells from ische-mic and hypoxic injury durlng the respiratory failure of cor pulmonale.