联合高压氧治疗肝硬化门脉高压疗效观察

Therapeutic effect of hyperbaric oxygen on cirrhotic patients with portal hypert ension

目的通过观察肝硬化门脉高压食管胃底静脉曲张患者经高压氧治疗后门静脉系统血流动力学和肝功能的变化,尝试探索高压氧在改善肝功能、预防肝硬化食管静脉曲张再出血维持治疗中的作用。方法2003年1月～2004年12月期间,36例肝炎后肝硬化食管静脉中～重度曲张的住院患者,随机分为3组:高压氧组12例,内科常规联合高压氧治疗2周,每日1次,每次2小时;心得安组12例,心得安10mg及单硝酸异山梨酯20mg,分别为每日3次及2次口服,连续2周;对照组12例内科常规治疗2周。运用彩色多普勒血管超声检测3组患者治疗前后门静脉直径(PV)、脾静脉直径(SV)和门静脉平均血流速度(Vmean)及脾脏厚度的变化,并计算门静脉血流量。同步检测3组患者治疗前后肝功能,前白蛋白(PA)、凝血酶原时间(PT)及吲哚氰绿15min潴留率(ICG15)的变化。结果高压氧组与心得安组血流动力学指标均有不同程度改善,门静脉血流量减少,门脉压力降低;而高压氧组肝功能改善明显优于心得安组及对照组。结论高压氧对防治肝硬化门脉高压食管静脉曲张再出血及改善肝功能具有潜在的治疗作用。

Objective To evaluate the changes of hemodynamics and liver function s on hepatocirrhosis with portal hypertension by hyperbaric oxygen therapy, and to explore the effects on prevention of variceal re-bleeding and in improving li ver functions. Methods 36 patients of cirrhosis with portal hypertension and mod erate to severe esophageal varices were randomly allocated into 3 groups consist ing of 12 patients each. The first group were to receive HBO by based on routine treatment for two hours a day for 14 days; Group 2 were to receive propranolol 10 mg orally three times and isosorbide mononitrate 20 mg two times orally a da y for 14 days; and the third group were the control group with a routine treatme nt. The diameter of portal vein (PV), splenic vein(SV) and average flow velocity of PV(Vmean)and spleen thickness were measured before and after therapy by usin g Doppler ultrasonography. At the same time, blood levels of liver function with PA? PT and ICG15 were also measured before and after the treatment. Results Th e parameter of hemodynamics on the group 1 with HBO and group 2 with propranolol had a more significant change, including the change in flow volume of PV and th e decrease in portal tension. Group 1 with HBO showed a significantly better res ult on liver function than the other 2 groups: propranolol and control. Conclusion HBO has shown a significant effect in prevention of esophageal and gastric variceal re-bleeding and also improvements on liver functioning in cirrhotic p atients with portal hypertension.