高压氧治疗对肝硬化门脉高压症患者血流动力学的影响

Effect of hyperbaric oxygen therapy on hemodynamics of cirrhotic patients with portal hypertension

目的:研究高压氧(HBO)治疗对肝硬化门脉高压患者的作用,并探讨其机制.方法:选取肝硬化门脉高压患者12例接受HBO治疗.观察内毒素和一氧化氮(nitricoxide,NO)水平?肠黏膜通透性?网状内皮系统功能及血流动力学指标在HBO前后变化;另设正常对照组8人,比较两组间肠黏膜通透性?网状内皮系统功能的差异.结果:肝硬化组的肠黏膜通透性(L%/M%)增高(0.04±0.02to0.09±0.03,P<0.01),而网状内皮系统吞噬功能(O)低于正常(74.1±1.4to64.8±3.8,P<0.01).HBO治疗后,患者的网状内皮系统功能恢复(64.8±3.8to70.0±3.0,P<0.01),内毒素(0.41±0.48)x103Eu·L-1to(0.24±0.31)x103Eu·L-1,P<0.01?NO(144±95.1)umol·L-1to(88±85)umol·L-1,P<0.01较前下降;脾脏厚度(7.7cm±1.4cmto7.4cm±1.1cm,P<0.01)?门脉宽度(1.53cm±0.13cmto1.41cm±0.13cm,P<0.05)及门脉血流速度(14.6cm.s-1±2.1cm.s-1to15.9cm.s-1±2.4cm.s-1,P=0.053)减少.结论:HBO能改善了肝硬化患者的门脉高压和高动力循环状态.其作用机制可能与增加网状内皮系统功能,减少血中内毒素及NO有关.

AIM:To investigate the effect of hyperbaric oxygen therapy (HBO) on hemodynamics of patients with portal hypertension and its mechanism. METHODS:Twelve cirrhotic patients with portal hypertension wer e chosen to receive HBO. Blood level of NO and endotoxin, parameters of hemodyna mic, function of reticulo-endothelial phagocytosis and permeability of intestin al mucosae were measured before and after HBO.Eight of healthy volunteers wore c hosen for control. The reticulo-endothelial phagocytic function and intestinal m ucosal permeability of control group were measured and compared with that of the cirrhotic group. RESULTS:The cirrhotic group showed a significant increase in in testinal mucosal permeability(L%M%)(0.04±0.02 to 0.09±0.03, P<0.01)and decrease in reticulo-endothelial phagocytic function(O) (74.1±1.4 to 64.8±3 .8, P<0.01). After HBO, there was a significant improvement in reticulo-end othelial phagocytic function(64.8±3.8 to 70.0±3.0, P<0.01) and decrease in the level of NO(144±95)umol·L-1 to (88±85)umol.L-1,P<0.01) and endotoxin(0.41±0.48)x103EU·L-1 to (0.24±0.31)x103Eu·L-1 , P<0.01), the thickness of spleen (7.7±1.4)cm to (7.4±1.1)cm, P<0.0 1), the diameter (1.5±0.1)cm to (1.4±0.13)cm, P<0.05) and blood flow veloc ity (14.6±2.1)cm.s-1 to (15.9±2.4)cm.s-1 P=0.053) of portal vein in cirrhosis group.CONCLUSION:HBO can alleviate portal hypertension and hyperdyna mic circulation. Its mechanism is to enhance reticulo- endothelial phagocytic fu nction and reduce the concentration of NO and endotoxin in systemic circulation.