Changes of hepatic and systemic haemodynamics following somatostatin administration in patients with hepatitis B-related cirrhosis.
Somatostatin has been used to effectively control acute variceal haemorrhage, with conjectured mechanisms on portal hypertension. We, therefore, evaluated the effects of somatostatin on hepatic and systemic haemodynamics in 15 patients with hepatitis B-related cirrhosis and portal hypertension. All patients received an intravenous, continuous infusion of somatostatin 250 micrograms/h, following a bolus injection of 250 micrograms. In systemic haemodynamics, the mean arterial pressure (MAP) increased (P < 0.05), associated with a reflex bradycardia within 3 min following bolus injections, compared with basal values. The right atrial pressure, pulmonary capillary wedge pressure, inferior vena cava pressure, cardiac index, and systemic vascular resistance remained unaffected after drug infusion. In hepatic haemodynamics, the wedge hepatic vein pressure remained unchanged after drug administration. However, there was an increase in free hepatic vein pressure (FHVP; P < 0.05), and a trend toward a decrease in the hepatic vein pressure gradient (HVPG; P = 0.063), within 3 min after bolus injection. Furthermore, the hepatic blood flow decreased significantly at 10 and 30 min after somatostatin infusion (P < 0.05). The effective sinusoidal perfusion assessed by indocyanine green infusion also decreased progressively at 10 min (P = 0.057) and 30 min (P < 0.05). We concluded that somatostatin, at the dose used in this study, caused a transient and bolus-related vasoconstrictive effect, resulting in increases in MAP and FHVP, a decrease in heart rate, and a trend toward lower HVPG. In addition, somatostatin reduced the hepatic blood flow and effective sinusoidal perfusion which may be hazardous to cirrhotic patients during variceal haemorrhage.
Hsia
H C
HC
Department of Medicine, Veterans General Hospital, Taipei, Taiwan, Republic of China.
Lin
H C
HC
Lee
F Y
FY
Tsai
Y T
YT
Lee
S D
SD
Meng
H C
HC
Chao
Y
Y
Wang
S S
SS
Lo
K J
KJ
D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy / Q000503:physiopathology*; D008102:Liver Circulation / Q000187:drug effects*; D008103:Liver Cirrhosis / Q000382:microbiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D013004:Somatostatin / Q000494:pharmacology* / Q000627:therapeutic use; D013997:Time Factors
D013004:Somatostatin