Effect of oral propranolol on splanchnic oxygen uptake and haemodynamics in patients with cirrhosis

Flemming Bendtsen, Jens H. Henriksen*, Ulrik Becker, Thorkild I.A. Sørensen

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Abstrakt

In order to elucidate the effect of beta-adrenergic blockade on liver metabolism and haemodynamics, splanchnic oxygen uptake, hepatic removal of indocyanine green (ICG) and splanchnic and systemic haemodynamics were studied in 13 patients with cirrhosis before and 1.5-2 h after an oral dose of 80 mg propranolol. All patients underwent hepatic vein catheterization and had a primed continuous intravenous infusion of ICG. Azygos vein catheterization was performed in six patients. Splanchnic (hepatic-intestinal) oxygen uptake (median control 68 ml/min vs. beta-blockade 56 ml/min, P < 0.01), azygos venous oxygen saturation (76 vs. 67%, P < 0.05), ICG clearance (263 vs. 226 ml/min, P < 0.01), wedged-to-free hepatic vein pressure (16 vs. 13.5 mm Hg, P < 0.01), hepatic blood flow (1.18 vs. 0.78 l/min, P < 0.01), cardiac index (3.42 vs. 2.53 l/min·min2, P < 0.01), and heart rate (72 vs. 56 beats per min, P < 0.01) decreased significantly after oral beta-blockade. The hepatic extraction ratio of ICG increased significantly (0.32 vs. 0.45, P < 0.01), whereas estimated 'intrinsic' ICG clearance (289 vs. 300 ml/min, n.s.), arterial blood pressure, stroke volume, and systemic vascular resistance remained essentially unchanged. The results indicate that besides the well-known cardiovascular effects of propranolol, beta-adrenergic blockade may also reduce hepatic metabolic functions as evidenced by the significantly decreased splanchnic oxygen uptake. The raised hepatic extraction ratio of ICG may be caused by reduction in hepatic blood flow as well as in intrahepatic shunting.

OriginalsprogEngelsk
BogserieJournal of Hepatology
Vol/bind5
Udgave nummer2
Sider (fra-til)137-143
Antal sider7
ISSN0168-8278
DOI
StatusUdgivet - 1. jan. 1987

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