肝硬変症による食道静脈瘤の術後管理におけるhyperdynamic stateの意義:dobutamineの効果 CLINICAL SIGNIFICANCE OF THE HYPERDYNAMIC STATE IN THE IMMEDIATE POSTOPERATIVE PERIOD IN ESOPHAGEAL VARICES DUE TO LIVER CIRRHOSIS:THE EFFECT OF DOBUTAMINE

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Abstract

肝硬変に起因する食道静脈瘤に対し,経胸食道離断術を行った16例及び胃上部血行遮断・摘脾術を行った8例について,術直後よりdobutamineを投与した症例と投与しない症例に分け,それぞれの循環動態,酸素需給状態を比較することにより,術後のhyperdynamic stateの意義について検討した. <BR>経胸食道離断術症例では循環動態,酸素需給状態にdobutamineの使用の有無による違いを見い出すことはできなかったが,胃上部血行遮断・摘脾術症例においてはdobutamineを用いることにより,心係数が増加し,分時酸素運搬量が維持され,酸素消費量が増加した.また,有効肝血流量を反映するとされているICG消失率はdobutamine投与群ではよく保持されたが,非投与群では低下がみられた. <BR>胃上部血行遮断・摘脾術後の循環動態,酸素需給状態さらに有効肝血流量を維持する上で,術後にdobutamineを用いてhyperdynamic stateを保つことは有意義であると思われた.

To determine postoperative significance of hyperdynamic state in esophageal varices due to liver cirrhosis, sixteen patients undergone transthoracic esophageal transection and eight undergone devascularization of the proximal stomach and splenectomy were divided into two groups, either of which was given dobutamine, 3μg/kg/min, d.i.v., immediately after surgery and the remaining was not given. The two groups were compared in systemic hemodynamics and oxygen metabolism. <BR>Dobutamine had no effect on systemic hemodynamics and oxygen metabolism after transthoracic esophageal transection. In patients undergone devascularization of the proximal stomach and splencetomy, however, dobutamine increased the cardiac index and oxygen consumption and maintained oxygen delivery. Furthermore, in these patients given dobutamine the ICG-K value which reflects hepatic blood flow, was maintained whereas it was decreased in controls. <BR>These results suggest that, to support systemic hemodynamics, oxygen metabolism and hepatic blood flow in patients who have undergone devascularization of the proximal stomach and splenectomy for esophageal varices due to liver cirrhosis, maintenance of postoperative hyperdynamic state with dobutamine is important.

Journal

  • The journal of the Japanese Practical Surgeon Society

    The journal of the Japanese Practical Surgeon Society 50(6), 1099-1104, 1989

    Japan Surgical Association

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