CLINICAL SIGNIFICANCE OF THE HYPERDYNAMIC STATE IN THE IMMEDIATE POSTOPERATIVE PERIOD IN ESOPHAGEAL VARICES DUE TO LIVER CIRRHOSIS

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. 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. 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.