彩色多普勒超声评价肝移植术后肝动脉血流动力学改变及其临床意义

Assessment of the hemodynamic changes of hepatic artery with color Doppler ultrasound and the corresponding clinical meanings after orthotopic liver transplantation

目的 探讨肝移植术后肝动脉血流动力学改变及其临床意义。方法 回顾性分析术后接受了系列多普勒超声检查的42例肝移植患者，依肝右动脉阻力指数（RI）不同分为低阻力型（RI＜0．5）、阻力正常型（0．5≤RI＜0．8）、高阻力型（RI≥0．8）。分析术后肝右动脉收缩期峰值流速（PSV）和RI的变化及其与患者术后2月内病情转归的关系。结果 肝移植术后第1～3d肝右动脉RI测值中，64．3％为阻力正常型，26．2％为高阻力型，9．5％为低阻力型。肝右动脉PSV术后早期测值偏低，之后逐渐上升。RI值于术后早期测值偏高，之后逐渐减低。肝移植术后2月内死亡或危重的患者共9例，其中6例（66．7％）术后第1～3d肝右动脉PSV％30cm／s和（或）RI＜0．5。结论 肝移植术后早期肝动脉RI增高是一种常见的表现，与临床表现无关；术后早期肝右动脉PSV＜30cm／s和（或）RI〈0．5会导致术后早期高死亡率。

Objective To study the hemodynamic changes of hepatic artery and the corresponding clinical meanings after orthotopic liver transplantation. Methods Forty-two patients of orthotopic liver transplantation （OLT） were received series exams of Doppler ultrasound. The patients were grouped with different resistant index （RI） of right hepatic artery as hypo-resistance（RI〈0.5） ,normal-resistance（0.5≤RI〈0.8） and hyper-resistance （RI≥0.8）. The relationships of the changes of peak systolic velocity （PSV） and RI of right hepatic artery with the prognosis of patients in the early 2 months after OLT were also analyzed. Results Spectrum values of right hepatic artery in the 1-3 days after OLT were obtained with normal-resistance of 64.3%, hyper-resistance of 26.2 % and hypo-resistance of 9.5 %. The values of PSV of right hepatic artery were relatively low in the early time and would increase gradually. The values of RI of right hepatic artery were relatively high in the early time and would decrease gradually. There existed 9 dead（or dying when discharged with economic reason） patients in the early 2 months after OLT,among which 6 （66.7%） patients were found with RI〈0.5 and/or PSV〈30 cm/s of the spectrum values of right hepatic artery. Conclusions The high RI of hepatic artery in the early time after OLT is a usual phenomenon and have no relationship with clinical manifestations;PSV〈30 cm/s and/or RI〈0.5 of right hepatic artery in the early time after OLT will induce high fatality.