川崎 俊彦¹, 森安 史典¹, 木村 達¹, 山下 幸孝¹, 染田 仁¹, 玉田 尚¹, 小野 成樹¹, 梶村 幸三¹, 濱戸 教行¹, 内野 治人¹, 中村 武史²

Toshihiko KAWASAKI¹, Fuminori MORIYASU¹, Tohru KIMURA¹, Yukitaka YAMASHITA¹, Hitoshi SOMEDA¹, Takashi TAMADA¹, Shigeki ONO¹, Kouzou KAJIMURA¹, Noriyuki HAMATO¹, Haruto UCHINO¹, Takefumi NAKAMURA²

¹京都大学医学部第1内科, ²赤穂市民病院内科

¹First Department of Internal Medicine, Faculty of Medicine, Kyoto University, ²Department of Medicine, Ako Municipal Hospital

キーワード : Dobutamine, Ultrasonic Doppler flowmeter, Splanchnic artery, Liver cirrhosis, Hyperdynamic circulatory state

Catecholamines (dobutamine, dopamine, etc.) have recently been used clinically in an attempt to increase hepatic blood flow and so prevent hepatic failure. Using a ultrasonic Doppler duplex system consisting of B–mode scanner and pulsed Doppler flowmeter, we investigated changes in common hepatic, splenic, superior mesenteric and femoral arterial blood flow in healthy adults and patients with chronic liver diseases (chronic hepatitis and liver cirrhosis) induced by infusion of dobutamine at rates of 2, 3, 5 μg⁄kg⁄min. We also investigated the changes in cardiac output induced by dobutamine in patients with and without chronic liver diseases at rates of 5 μg⁄kg⁄min.
The blood flow in splenic, superior mesenteric and femoral arteries of healthy adults significantly increased during infusion of dobutamine; that of patients with chronic hepatitis also tended to increase, but not significantly. In patients with liver cirrhosis, there was no apparent tendency in any direction. The changes that occurred in the healthy controls and patients with chronic hepatitis affected mainly cardiac output. In contrast to the changes in the splenic, superior mesenteric and femoral arteries, there was little change in common hepatic arterial blood flow in any group. Since there was no correlation in any one group between any tendency for change in the common hepatic arterial flow and the changes in other arteries, it was thought that one or more mechanisms exist to control the hepatic arterial circulation. The cardiac index in patients without liver diseases increased significantly; that in patients with chronic liver diseases also increased significantly, but to a lesser degree.
The most plausible explanation for these differences is that the hyperdynamic circulatory state in patients with chronic liver diseases modifies the changes induced by dobutamine in the hepatosplanchnic circulatory system. The change in the hepatic hemodynamics induced by dobutamine varied from patient to patient depending on whether or not they had liver diseases. It is therefore important to monitor the hepatic circulation when dobutamine is clinically used to prevent or treat hepatic failure.