간경변증 환자에서 Propranolol이 식후 문맥혈류에 미치는 영향

Abstract

Propranolol, a nonselective p-adrenergic blocker, has been shown to reduce portal pressure and the risk of variceal bleeding. It has been shown that in cirrhosis, portal pressure increases during postprandial states, caused by postprandial hyperemia, and it may be involved in in- ducing variceal bleeding. A double-blind randornized control study(crossover on 2 days apart) was designed to com- pare the effects of propranolol vs. placebo on portal flow in cirrhotic patients during fasting and after a standard liquid meal. Portal flow was measured with an Aloka SSD 650 Doppler system in 1 1 cirrhotic patients. Fasting portal flow and heart rate were obtained at baseline and 2 hours after the administration of propranolol or placebo. A standard test meal was then given, and measurements were repeated 30 minutes later. Five patients received placebo on day 1 and propranolol on day 3, whereas six patients received propranolol on day 1 and placebo on day 3. After propranolol administration, heart rate declined by 15.7%(p<0.001) and portal blood flow reduced by 17.2%(p<0.005). The postprandial portal blood flow percentage increase after the meal was similar for both placebo and propranolol. Propranolol did not blunt post- prandial hyperemia. However, whereas the absolute value of blood flow after the meal in- creased significantly in comparison with baseline in placebo-treated patients(p<0.005), this did not occur with propranolol. In conclusion, the absolute value of blood flow after a meal in propranolol-treated patients was reduced in comparison with placebo, and this action of propranolol may constitute a pro- tective effect of propranolol in portal hypertension.