奥曲肽对肝硬化门脉血流动力学的影响

目的 通过观察不同剂量生长抑素衍生物奥曲肽对肝硬化门脉高压性食管静脉曲张患者门静脉系统血流动力学变化的影响,同时与作用肯定的β受体阻滞剂心得安比较,尝试证实奥曲肽在预防肝硬化食管静脉曲张再出血维持治疗中的作用。方法 2001年1～12月期间,30例肝炎后肝硬化并食管静脉中～重度曲张的住院患者,随机分为3组：A组10例,心得安10～20mg、每日3次口服,7d。B组10例,奥曲肽0．05mg、每12h皮下注射,3d。C组10例,奥曲肽0．1mg、每12h皮下注射,3d。运用彩色多普勒血管超声技术探测上述3组患者给药前、后门静脉(PV),脾静脉(SV)及肠系膜上静脉(SMV)的血管内径及最大流速,并计算各静脉的平均流速和推导其血流量。结果 3组用药前后对血管直径均无影响;心得安组可降低PV的流速及流量,但对SV和SMV的流速及流量均无影响;不同剂量奥曲肽组均可分别降低PV、SV和SMV的流速及流量。此外,对PV流量的改变,奥曲肽0．1mg组优于心得安组,但奥曲肽0．05mg组与心得安组无差异;对SV及SMV流量的改变,不同剂量奥曲肽组均优于心得安组。结论 奥曲肽对预防门脉高压性食管静脉曲张再出血具有潜在的维持治疗作用。

The effects of octreotide on portal hemodynamics in patients with liver cirrhosis

ObjectiveTo compare the portal hemodynamic effects of different doses of somatostatin analogue octreotide (sandostatin) with beta-blocker (propranolol) on prevention of early variceal re-bleeding in patients with cirrhotic portal hypertension MethodsThirty patients of cirrhosis with moderate to severe esophageal varices were randomly allocated into three groups 10 patients in group A were given propranolol 10-20 mg orally three times a day for 7 days; 10 patients in group B were administrated octreotide 0 05 mg subcutaneously two times a day for 3 days, while 10 patients in group C received octreotide 0 1 mg subcutaneously two times a day for 3 days The postprandial vessel diameter, maximal and average flow velocity (Vmax/V) and flow volume of portal vein (PV), splenic vein (SV) and superior mesenteric vein (SMV) were measured before and after therapy by using Echo-Doppler technology ResultsThere was a trend of decrease of the vessel diameter in all the three groups ,but with no significant difference However, the average velocity and flow volume of PV were significantly diminished in the propranolol group (P<0 05), while there was no statistical change of them in SV and SMV groups In octreotide 0 05 mg and 0 1 mg group, the average velocity and flow volume of PV, SV and SMV were significantly decreased (P<0 05) Besides, octreotide 0 1 mg group but not 0 05 mg group was more active in decreasing flow volume of PV as compared with the propranolol group, while both octreotide groups were superior to the propranolol group in decreasing flow volume of SV and SMV ConclusionsOctreotide may have potential prophylactic effect in prevention of early variceal re-bleeding in cirrhotic patients with portal hypertension