慢性肝疾患の門脈圧に対するpropranololの効果 : vasopressin との比較

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The effects of propranolol on portal venous pressure were evaluated in 19 patients with hepatic cirrhosis and one with chronic aggressive hepatitis. After intravenous infusion of 5mg of propranolol for 10 minutes, wedged and free hepatic venous presure (WHVP, FHVP), estimated hepatic blood flow (EHBF), cardiac output and total systemic vascular resistance (TSR) were measured serially. Portal venous pressure (WHVP-FHVP) decreased significantly by 23% at 20 minutes after the start of infusion and the effect persisted for 50 minutes. The heart rate, cardiac index and EHBF reduced significantly by 13%, 24% and 13%, respectively, whereas TSR increased by 34%. After the infusion of vasopressin (0.2U/ml) for comparative purposes, portal venous pressure reduced by about 30% at 10 minutes, the difference of reduction in portal venous pressure between both agents being insignificant. Mean plasma propranolol concentration, measured by high liquid chromatography in 4 out of 20 patients, was 20.3±5.3ng/ml at 20 minutes after the start of infusion.<BR>These results reveal that propranolol may have efficacy for the reduction of portal venous pressure and that the effect may be maintained at the level of above 20ng/ml of plasma propranolol concentration.