[Systemic hemodynamics and oxygen metabolism after hepatectomy--effect of hyperdynamic systemic circulatory support...

This study was undertaken to evaluate inotropic effect of dobutamine (DOB) on systemic and hepatic hemodynamics after hepatectomy. Systemic hemodynamics after 70% hepatectomy using mongrel dogs was depressed and oxygen metabolism was disturbed. Whereas in the dogs administrated DOB after hepatectomy, systemic circulation was improved and oxygen metabolism was maintained in a favorable state. In these hepatectomized dogs, hepatic blood flow was increased after administration of DOB. Systemic hemodynamics after hepatectomy in 37 cases of cirrhotic hepatoma was studied. In 15 cases, 3 micrograms/kg/min of DOB was infused i.v.d. after operation, and remaining 22 cases were assessed without DOB as control group. In controls, systemic circulation was depressed and increase of peripheral oxygen demand was compensated by increase of oxygen extraction ratio. Whereas in DOB group, oxygen delivery increased according to hyperdynamic systemic circulation and was followed by increase of oxygen consumption. These favorable hemodynamic results in DOB group reflected on the postoperative prognosis of these patients; 5 of 22 in control group, whereas only 1 of 15 in DOB group died of hepatic failure postoperatively. It is concluded administration of DOB in cirrhotic hepatectomized patients maintained systemic circulation in a hyperdynamic state and this resulted in improvement of postoperative prognosis.