Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure 14 in need of inotropic support
Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure 14 in need of inotropic support
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DOI：
10.1016/j.jhep.2007.04.015
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发表时间：
2007-09-01
影响因子：
25.7
通讯作者：
Larsen, Fin Stolze
中科院分区：
文献类型：
--
作者：
Eefsen, Martin;Dethloff, Thomas;Larsen, Fin Stolze
背景/目标：在急性肝功能衰竭（ALF）中，用儿茶酚胺进行容量扩张和变力性支持有时不足以确保足够的血压和脑灌注。本研究的目的是确定特利加压素是否增加脑灌注、脑乳酸浓度和颅内压（ICP），并与去甲肾上腺素（NA）的效果进行比较。（中位年龄42.5岁;范围15-66岁; 5名需要正性肌力支持并放置ICP和脑微透析导管的女性）同时记录脑灌注压（CPP）、脑灌注（使用经颅多普勒超声（V-mean））和ICP。此外，在NA输注速率和/或i. v.增加之前和之后收集乳酸盐（[lactate]ec）和丙酮酸盐（[pyruvate]ec）的脑细胞外浓度。结果：NA和特利加压素均增加CPP和V-mean（p < 0.01）。在NA输注期间ICP也增加（p < 0.01），但特利加压素后没有。注射特利加压素后，脑[乳酸]ec从2.34（1.52-8.38）mmol/l降至1.99（0.03-4.83）mmol/l（p = 0.027），但在NA输注期间未降低（2.83（1.53-7.11）mmol/l）。NA组和特利加压素组的[乳酸]ec/[丙酮酸]ec比值均无变化（分别为20.7（13.2-40.0）和22.2（10.5-30.0））。结论：特利加压素可增加ALF患者的CPP和脑灌注，对ICP和脑[乳酸]ec影响不大。这些发现表明，特利加压素可能是有价值的，作为一种附加治疗NA输注，以确保脑活力。(C)2007年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background/Aims: Volume expansion and inotropic support with catecholamines are sometimes insufficient to ensure adequate blood pressure and cerebral perfusion in acute liver failure (ALF). The aim of this study was to determine if terlipressin increases cerebral perfusion, cerebral concentration of lactate and intracranial pressure (ICP), and to compare the effect with that of noradrenalin (NA).Methods: Ten patients (median age 42.5 yr; range 15-66; 5 women) who needed inotropic support and had an ICP and a cerebral microdialysis catheter placed had concomitant recording of cerebral perfusion pressure (CPP), cerebral perfusion (using transcranial Doppler sonography (V-mean)) and ICP. Also cerebral extracellular concentration of lactate ([lactate]ec) and pyruvate ([pyruvate]ec) was collected before and after an increase in the NA infusion rate and/or i.v.-injection of 1 mg terlipressin.Results: Both NA and terlipressin increased CPP and V-mean (p < 0.01). Also ICP increased during NA infusion (p < 0.01) but not after terlipressin. The cerebral [lactate]ec decreased after terlipressin injection from 2.34 (1.52-8.38) to 1.99 (0.03-4.83) mmol/l (p = 0.027) but not during NA infusion (2.83 (1.53-7.11) mmol/l). The [lactate]ec to [pyruvate]ec ratio remained unchanged in both the NA group (20.7 (13.2-40.0)) and terlipressin group (22.2 (10.5-30.0)).Conclusions: This study shows that terlipressin increases CPP and cerebral perfusion with little influence upon ICP and cerebral [lactate]ec in ALF patients. These findings indicate that terlipressin may be valuable, as an additive treatment to NA infusion to secure brain viability. (C) 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.