经颈内静脉肝内门体分流术对门静脉高压症患者门静脉及全身血流动力学影响

Influence of transjugular intrahepatic portosystemic stent shunts on portal and systemic hemodynamics of patients with portal hypertension

目的研究经颈内静脉肝内门体分流术（ＴＩＰＳＳ）对门静脉和全身血流动力学的影响。方法采用超声多普勒、直接门静脉测压和血气分析、ＳｗａｎＧａｎｚ导管对１５例门静脉高压症患者检测ＴＩＰＳＳ术前后门静脉、体循环和肺循环血流动力学的变化。结果ＴＩＰＳＳ术后３０分钟和２周，门静脉压力下降３４％和５５４％，氧分压和氧饱和度增加６７７％、２１３％和６８０％、２０４％。术后２周门静脉血流速度增加１４倍，心输出量显著增加（Ｐ＜００１），外周血管阻力和肺血管阻力显著下降（Ｐ＜００１），右心房压和肺动脉压增加（Ｐ＜００５）；肾血流量显著增加（Ｐ＜００１），肾功能明显改善。结论ＴＩＰＳＳ既有效降低门静脉压力和改善肾脏功能，又加重门静脉和全身血流高动力状态，应用时需加强心。

Objective To determine the influence of transjugular intrahepatic portosystemic stent shunts (TIPSS) on portal and systemic hemodynamics of patients with portal hypertenaion. Methods Fifteen patients who had undergone TIPSS with 10mm stents were studied. The parameters of portal, systemic and pulmonary hemodynamics were measured with Doppler sonography, direct portal pressure measurement, blood gas analysis and Swan Ganz catheter before and 30 min and 2 weeks after TIPSS. Result Portal pressure decreased by 34% and 55 4%, and PO 2, SatO 2 increased by 67 7%, 21 3% and 68%, 20 4% respectively 30 min and 2 weeks after TIPSS. Portal blood velocity increased by 1 4 times 2 weeks after TIPSS. CO, CI, SI increased ( P <0 01) and SVR, PVR decreaed ( P <0 01) after TIPSS. Also, RAP, PAP increased ( P <0 05).Renal blood flow increased ( P <0 01) and renal function significantly improved. Conclusion TIPSS can not only decrease portal pressure and improve renal function, but also worsen portal and systemic hemodynamics. Cardiac and liver function should be monitored before and after TIPSS.