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Selective bowel decontamination with norfloxacin has a positive effect on hemodynamics in patients with cirrhosis

Cirrhosis of the liver, whatever its etiology, is accompanied by a type of hyperdynamic hemodynamics, which is manifested by high cardiac output, low systemic vascular resistance and low blood pressure. This is due to many complications of cirrhosis, such as portal hypertension, the development of ascites, hepatorenal syndrome, etc. The main mechanism of vasodilation is the excessive production of nitric oxide - NO. Presumably, the cause of this phenomenon in cirrhosis may be an excessive growth or translocation of the intestinal flora, which is accompanied by an increase in the number of endotoxins or circulating cytokines (TNF-α) and an increase NO production due to the potentiation of the activity of oxidase synthetase II or III enzymes.

Based on the above assumption, a team of scientists led by B. Rasaratnam planned a randomized, double-blind, placebo-controlled study to determine the possible effect of selective intestinal decontamination using norfloxacin on local and systemic hemodynamics in patients with cirrhosis.

The study included 14 patients with confirmed alcoholic hepatic cirrhosis and 14 patients in the control group. Norfloxacin was chosen as the preparation for selective intestinal decontamination, which was prescribed to patients at a daily dose of 0.4 g for 4 weeks.

To determine the blood flow of the forearm, the method of occlusal venous plethysmography was used. Cardiac output and pressure gradient in the hepatic veins were measured after cardiac catheterization. Glomerular filtration was determined by insulin clearance. Plasma endotoxin levels were determined using a test using the limulus amibocyte lysate.

As a result of the study, norfloxacin has been shown to significantly reduce the level of endotoxin in the blood plasma (from 2.14 PIECES / ml, 95% CI - from -3.6 to -0.68 PIECES / ml), increased systemic vascular resistance (from 2.94 units, CI - from 0.74 to 5.11 units) and blood pressure indicators (from 8.7 mmHg, CI - from 2.65 to 14 , 73).

In addition, a decrease in the hepatic venous pressure gradient was observed in the norfloxacin group. The activity indices of the renin-angiotensin-aldosterone system (RAAS), which are generally high in patients with cirrhosis, have not changed significantly with the use of norfloxacin. Norfloxacin had no effect on glomerular filtration in patients with cirrhosis.

Thus, selective intestinal decontamination with norfloxacin has positive effects on the type of hyperdynamic blood circulation without negatively affecting the blood flow of organs or kidneys in this category of patients.