肝硬化患者门静脉系统血流动力学改变的彩色多普勒超声研究

Study on the changes of portal hemodynamics by color Doppler ultrasonography in patients with cirrhosis

目的 观察肝硬化患者门静脉系统血流动力学的改变及其与肝功能Child Pugh分级、上消化道出血的关系。方法 31例肝硬化患者于空腹静息状态下取仰卧位行彩色多普勒超声探查门静脉系统。结果 肝硬化组的门静脉、脾静脉及肠系膜上静脉直径增宽 ,血流速度显著下降 ;脾静脉血流量 (Qsv)显著高于正常对照组 ( 748 90± 382 16ml/minvs 2 42 96± 113 5 3ml/min ,P <0 0 1)。肝硬化出血组脾静脉、肠系膜上静脉直径增宽、流速加快、血流量明显增多。Child PughC级患者门静脉流速及门静脉血流量明显 (Qpv)低于A级、B级。结论 食管静脉曲张上消化道出血与脾静脉、肠系膜上静脉血流量显著增加、Qsv/Qpv比值增大密切相关 ;而门静脉流速及门静脉血流量随肝功能恶化而明显下降。因此 ,动态观测上述指标对判断门静脉高压上消化道出血的危险性及肝功能状况有重要临床意义。

Aim To observe the changes of portal hemodynamics in cirrhotic patients with color Doppler ultrasonography and to study the relationship between portal hemodynamics and the Child Pugh classification as well as upper gastrointestinal variceal hemorrhage.Methods In 31 portal hypertensive cirrhotic patients,portal systemic hemodynamical parameters were studied with color Doppler ultrasonography.Results Compared to the nomal control the diameters of portal vein,splenic vein and superior mesenteric vein were higher, while their flow velocity was lower,and there was a significant increase in splenic blood flow rate in cirrhotic patients(748 90±382 16 ml/min vs 242 96±113 53 ml/min, P <0 01)?The diameters and flow volume as well as blood flow rate of splenic vein and superior mesenteric vein were markedly higher in cirrhosis with hemorrhage than those without hemorrhage.As for patients with different liver function, portal flow velocity and blood flow volume were lower in Child Pugh C group than in Child Pugh B and Child Pugh A group.Conclusion Upper gastrointestinal variceal hemorrhage is associated with the increase of blood flow volume of splenic vein and superior mesenteric vein.And portal flow significantly decrease in cirrhotic patients with worsening Child Pugh classification.