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Sauerstoffuntersättigung und veränderte Hämodynamik bei Lebercirrhose

Arterial oxygen unsaturation and hemodynamic changes in cirrhosis of the liver

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Summary

Cirrhosis of the liver is frequently accompanied by circulatory and respiratory changes. Among the main pathological modifications one finds: (1) vascular changes of the skin, (2) increased peripheral blood flow, (3) reduced vascular resistance, (4) shortened circulation time, (5) increased blood volume, (6) increased cardiac output, (7) hyperventilation, (8) arterial unsaturation. Some investigations make it probable that the arterial unsaturation is caused by intrapulmonary shunts.

The cause of decreased vascular resistance, vaso-dilatation and arterial-venous shunts has not been sufficiently clarified. Theoretically, the most probable explanation is that a unidentified vasoactive material is responsible. This could be histamine, bradykinin or any other substance with might be less metabolized in the diseased liver or in the lung. In own investigations the intrapulmonary shunt volume of venous admixture during histamine infusion was measured in patients with cirrhosis and in controls. In normals the venous admixture was 4.5% of the cardiac output before and 5.1% during histamine administration and in cirrhotics 12.4% before and 17.2% with histamine administration.

Besides, a considerable increase in cardiac output and the lowering of peripheral resistance during histamine administration show that an already existing tendency to increased blood flow may very easily be intensified in cirrhotic patients. Thus the available evidence from this model indicates that a vasodilator substance probably affects the vascular system of these patients at various sites.

Zusammenfassung

Die Lebercirrhose ist häufig mit zirkulatorischen sowie respiratorischen Veränderungen vergesellschaftet. Die auffälligsten Befunde dabei sind 1. Gefäßveränderungen der Haut 2. Zunahme der peripheren Durchblutung 3. Reduktion des peripheren Widerstandes 4. Verkürzung der Zirkulationszeit 5. erhöhtes Blutvolumen 6. Zunahme des Herzminutenvolumens 7. Hyperventilation 8. O2-Untersättigung des arteriellen Blutes. Für die arterielle Untersättigung wurde u.a. eine Zunahme der venösen Beimischung infolge von intrapulmonalen Shunts verantwortlich gemacht. Die Ursache für das Auftreten intrapulmonaler Kurzschlußverbindungen konnte bisher nicht eindeutig geklärt werden. Es wurden vaso-aktive Substanzen dafür verantwortlich gemacht, die jedoch bisher nicht näher identifiziert werden konnten. Eigene Untersuchungen zeigten, daß es bei Patienten mit Lebercirrhose durch intravenöse Applikation von Histamin zu einer statistisch signifikanten Zunahme der venösen Beimischung kam, während diese Zunahme bei einem Kontrollkollektiv nicht nachweisbar war. Auch andere bei Patienten mit Lebercirrhose vorhandene Abnormalitäten der Zirkulation konnten durch Histamin modellhaft nachgeahmt bzw. verstärkt werden.

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  1. Medizinische Universitätsklinik Marburg a.d. Lahn, Germany

    G. Baltzer, H. Arndt & G. A. Martini

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Ein Teil der im Text erwähnten eigenen Untersuchungen wurden dankenswerter Weise durch eine Stiftung des Verbandes der Lebensversicherungsunternehmen unterstützt.

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Baltzer, G., Arndt, H. & Martini, G.A. Sauerstoffuntersättigung und veränderte Hämodynamik bei Lebercirrhose. Klin Wochenschr 51, 1033–1042 (1973). https://doi.org/10.1007/BF01468316

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