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Hyposensitivity to vasopressin in patients with hepatitis B–related cirrhosis during acute variceal hemorrhage
Author(s) -
Tsai YangTe,
Lee FaYauh,
Lin HanChieh,
Lee ShouDong,
Hsia HsiaoChung,
Lin WenJeh,
Wang SunSang,
Lay ChiiShyan,
Lai KwokHung,
Lo KwangJuei
Publication year - 1991
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840130304
Subject(s) - vasopressin , medicine , cirrhosis , portal venous pressure , shock (circulatory) , blood pressure , hemodynamics , gastroenterology , anesthesia , heart rate , portal hypertension , cardiology , central venous pressure
It has been suggested that vasopressin given during hemorrhage may be less effective than when given during a stable state in a portal‐hypertensive rat model. This study was designed to evaluate the hemodynamic response to vasopressin infusion in 25 HBsAgpositive cirrhotic patients. Nine patients had active variceal hemorrhage before vasopressin infusion, and the other 16 patients were in a stable condition at the time of infusion. The two groups of patients were similar in baseline values except that a higher heart rate was found in patients with hemorrhage (96 ± 20 vs. 73 ± 10 beats/min, mean ± S.D., p < 0.01). Thirty minutes after vasopressin infusion (0.66 units/min), hepatic venous pressure gradient significantly decreased in both bleeding and stable patients (from 21 ± 9 to 18 ± 9 mm Hg, p < 0.05; and from 18 ± 4 to 8 ± 3 mm Hg, p < 0.000 1, respectively). However, the decrease of hepatic venous pressure gradient was less obvious in bleeding patients as compared with stable patients (4 ± 3 vs. 9 ± 2 mm Hg, p < 0.0001). A significant reduction of hepatic venous pressure gradient after vasopressin infusion was found in five bleeding patients without shock (from a median of 16 mm Hg [range = 12 to 26] to 11 mm Hg [range = 6 to 18], p < 0.05), but not in four bleeding patients with shock (from 28 [range = 15 to 36] to 25 [range = 18 to 33] mm Hg, p > 0.05). Vasopressin infusion resulted in a significantly lower heart rate and cardiac output with a concomitantly higher systemic vascular resistance in both groups of patients (p < 0.05). Mean arterial pressure increased after vasopressin infusion in stable patients (p < 0.000 1), but it remained unchanged in bleeding patients (p > 0.05). These findings confirm that vasopressin given during acute variceal hemorrhage, especially in cirrhotic patients with shock, may be less effective than when given during a stable state. (H EPATOLOGY 1991;13:407–412.)