[Studies on systemic hemodynamics and sympathetic nervous activity in portal hypertension].
Hemodynamic study was carried out in 53 preoperative cirrhotic patients with portal hypertension and the postoperative prognosis was evaluated. In 16 cases of these patients, cardiovascular responsiveness to cold stress and 60 degrees head up tilt was measured using pneumoplethysmography and Swan-Ganz catheter. In comparison with the controls, cirrhotic patients were in significant hyperdynamic state. Mortality rate from hepatic failure within 2 years after operation was significantly high in the group characterized by higher cardiac index (CI) level exceeding 4.0 l/min/m2 combined with lesser K-ICG level lower than 0.08/min or lesser hepatic extraction rate of ICG (ER) level lower than 50%. Cardiovascular responsiveness to reflex autonomic stimulation was significantly impaired in cirrhotic patients. The reaction index to cold stress was inversely correlated to plasma noradrenaline (NA) concentration. There was a tendency that the higher the corrected wedged hepatic pressure (WHVP) was, the lower the reaction index was. There was also a correlation between NA and corrected WHVP and plasma tyrosine concentration and ER. In summary, impaired liver function and increase of portal pressure, which might induce deranged catecholamine metabolism, may play an important role in decrease in cardiovascular responsiveness to reflex autonomic stimulation in cirrhotic patients with portal hypertension.
Nikkuni
K
K
Department of Surgery, Niigata University School of Medicine, Japan.
D005260:Female; D006439:Hemodynamics; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013564:Sympathetic Nervous System / Q000503:physiopathology*