EFFECTS OF DOBUTAMINE ON HEPATOSPLANCHNIC HEMODYNAMICS IN PATIENTS WITH CHRONIC LIVER-DISEASE

Background: It is said that catecholamines increase hepatic blood flow in patients without Liver diseases, although several reports have sug gested a blunted response to catecholamines in patients with liver cir rhosis. Methods: We investigated changes in splanchnic blood flow dist ribution induced by the infusion of dobutamine into peripheral veins o f healthy adults (NC group), patients with chronic hepatitis (CH group ), and patients with liver cirrhosis (LC group), using a Doppler duple x system (protocol 1). We also investigated changes in hepatic hemodyn amics induced by dobutamine infusion in patients with liver cirrhosis (cirrhosis group) and patients without liver diseases (control group), using hepatic catheterization (protocol 2). Results: In protocol 1 th e average increase in portal venous blood flow during dobutamine infus ion was significant in the NC and CH groups but was not significant in the LC group. Changes in the blood how in the splenic artery and vein , superior mesenteric artery and vein, and femoral artery were similar to those in the portal Vein in each of the three groups. Infusion did not cause a change in the common hepatic arterial Row in any of the t hree groups. In protocol 2 the portal Venous flow, cardiac index, and hepatic venous pressure gradient increased significantly during dobuta mine infusion in both the cirrhosis and the control groups. Hepatic va scular resistance in the cirrhosis group increased slightly, whereas, in contrast, that in the control group increased significantly. The ra te of change in almost all variables was lower in the cirrhosis group than in the control group. Conclusion: These results indicate that dob utamine has less effect on hepatic circulation in patients with liver cirrhosis than in those without liver diseases, indicating that the va lue of dobutamine in increasing hepatic blood flow in cirrhotic patien ts is very limited.