输注去甲肾上腺素对肝血流量的影响及其与生长抑素相互作用

输注去甲肾上腺素对肝血流量的影响及其与生长抑素相互作用：一项观察性队列研究      

贵州医科大学  麻醉与心脏电生理课题组

翻译：张中伟   编辑：潘志军   审校：曹莹

背景： 去甲肾上腺素(NE)是一种α1-肾上腺素能受体激动剂，在围手术期低血压的治疗中起着关键作用。除调节全身血流动力学外，去甲肾上腺素还可能影响局部血流，如肝脏循环，其中含有多种肾上腺素能受体。它可能通过减少门静脉血流量(PVF)或肝动脉血流量(HAF)改变局部血管紧张度和肝血流量(HBF)。本研究的目的是评估去甲肾上腺素对肝血流量的影响。

NO.1

方法： 本研究纳入计划行胰腺十二指肠切除术的患者。所有患者都接受了使用丙泊酚和瑞芬太尼的标准化麻醉管理，并在Pulsioflex™指导下使用目标导向的血流动力学策略进行血流动力学稳定管理。在手术适应征上，给予生长抑素(生长抑素)减少胰腺分泌。使用渡越时间超声(MEDITIM™)进行肝血流量测量。胰腺切除后，在T1时进行血流动力学和肝血流量基线测量。然后，开始注射NE，使平均动脉压(MAP)分别增加至基线MAP的10-20%(T2)和基线MAP的20%-30%(T3)。在这三个时间点同时进行肝血流量和血流动力学检测。 NO.2        NO.3 结果:   本研究对28例患者进行了分析。NE可显著升高MAP，但对心脏指数无明显影响。NE输注可明显降低肝动脉血流量（HAF）(p<0.01)，但对门静脉血流量(PVF)的影响尚不清楚。分析显示，接受生长抑素治疗的患者PVF在基线时显著降低(p<0.05)，在NE输注期间无明显变化。在这些患者中，总肝血流量(HBF)的减少主要与HAF的减少有关(p<0.01)。在未经治疗的患者中，NE输注后总HBF降低(P<0.01)，PVF降低(P<0.05)。          

NO.4 结论: NE可通过降低HAF来降低总HbF，但对PVF的影响尚不清楚。接受生长抑素治疗的患者在基线时PVF较低，在NE输注期间不受影响。在这些患者中，合并NE的总HBF的下降与HAF的下降有关。在未接受生长抑素治疗的患者中，输注去甲肾上腺素后PVF也显着降低。     

原始文献来源：

Jurgen van Limmen, Xavier Iturriagagoitia, et al.Effect of norepinephrine infusion on hepatic blood flow and its interaction

with somatostatin: an observational cohort study.[J]. BMC Anesthesiol(2022) 22:202.

 罂粟花  

Effect of norepinephrine infusion on hepatic blood flow and its interaction with somatostatin: an observational cohort study

Abstract

Background: Norepinephrine (NE) is a α1-adrenergic mediated vasopressor and a key player in the treatment of perioperative hypotension. Apart from modulating systemic hemodynamics, NE may also affect regional blood flow, such as the hepatic circulation, which contains a wide variety of adrenergic receptors. It may alter regional vascular tonus and hepatic blood flow (HBF) by reducing portal vein flow (PVF) or hepatic arterial flow (HAF). The aim of this study was to assess the effects of NE on HBF .

Method: Patients scheduled for pancreaticoduodenectomy were included. All patients received standardized anesthetic care using propofol and remifentanil and were hemodynamically stabilized using a goal-directed hemody- namic strategy guided by Pulsioflex™. On surgical indication, somatostatin (SOMATO) was given to reduce pancreatic secretion. HBF measurements were performed using transit-time ultrasound (Medistim™). Baseline hemodynamic and HBF measurements were made after pancreatectomy, at T1. Afterwards, NE infusion was initiated to increase mean arterial pressure (MAP) by 10 – 20% of baseline MAP (T2) and by 20 – 30% of baseline MAP (T3). HBF and hemody- namic measurements were performed simultaneously at these three time-points..

Results: A total of 28 patients were analyzed. Administration of NE significantly increased MAP but had no effect on cardiac index. NE infusion reduced total HBF in all patients (p < 0.01) by a reduction HAF (p < 0.01), while the effect on PVF remained unclear. Post-hoc analysis showed that SOMATO-treated patients had a significant lower PVF at baseline (p < 0.05), which did not change during NE infusion. In these patients, reduction of total HBF was primarily related to a reduction of HAF (p < 0.01). In untreated patients, NE infusion reduced total HBF both by a reduction HAF (p < 0.01) and PVF (p < 0.05)..

Conclusion: Administration of NE reduced total HBF , by decreasing HAF , while the effect on PVF remained unclear. SOMATO-treated patients had a lower PVF at baseline, which remained unaffected during NE infusion. In these patients the decrease in total HBF with NE was entirely related to the decrease in HAF . In SOMATO-untreated patients PVF also significantly decreased with NE.

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