高压氧治疗对肝硬化门脉高压患者血流动力学及血浆内毒素、一氧化氮水平的影响

Effect of Hyperbaric Oxygen Therapy on Hemodynamics and Levels of Plasma Endotoxin and Nitric Oxide in Patients with Cirrhotic Portal Hypertension

目的 探究肝硬化门脉高压(PHT)患者行高压氧(HBO)治疗对血流动力学及血浆内毒素、一氧化氮(NO)的影响。方法 选取2018年1月至12月西安交通大学第二附属医院肝硬化PHT患者36例为观察组,进行HBO治疗;并选择同期36名正常健康者为对照组,比较两组血流动力学情况、网状内皮系统功能及肠黏膜通透性。结果 经HBO治疗后,观察组的门脉宽度及脾脏厚度显著减少,门脉血流速度明显增快,与治疗前比较,差异均有统计学意义(P <0.05),而平均动脉压、心率无显著变化(P> 0.05)。与对照组比较,治疗后观察组的肠黏膜通透性显著增高,网状内皮系统吞噬功能显著较低,差异均有统计学意义(P <0.05)。治疗后观察组的网状内皮系统吞噬功能好转(P <0.05),NO浓度和血浆内毒素水平下降(P <0.05),超氧化物歧化酶、丙二醛及肠黏膜通透性无显著变化,差异无统计学意义(P> 0.05)。结论 肝硬化PHT患者采用HBO治疗,可减少血中内毒素,改善高动力循环状态及PHT,其作用机制可能与增加网状内皮系统功能有关。

Objective To investigate the effect of hyperbaric oxygen therapy(HBO)on hemodynamics and levels of plasma endotoxin and nitric oxide(NO)in patients with cirrhotic portal hypertension(PHT).Methods From January to December 2018,36 patients with cirrhotic PHT in the Second Affiliated Hospital of Xi'an Jiaotong University were selected as the observation group for HBO,and 36 normal healthy persons were selected as the control group.Hemodynamics,reticuloendothelial system function,and intestinal mucosal permeability were compared between two groups.Results Compared with those before treatment,the portal vein width and spleen thickness of the observation group were significantly decreased after HBO,and the blood flow velocity of portal vein was increased rapidly(all P<0.05),while the mean arterial pressure and heart rate did not change significantly(P>0.05).Compared with the control group,the intestinal mucosal permeability of the observation group was significantly higher,the phagocytic function of the reticuloendothelial system was significantly lower(P<0.05).Compared with those before treatment,the phagocytic function of reticular endothelium system of the observation group was improved after HBO(P<0.05),NO and plasma endotoxin levels were decreased(P<0.05),but SOD,MDA,and intestinal mucosal permeability did not obviously change(P>0.05).Conclusion For patients with cirrhotic PHT,HBO can reduce endotoxin level in blood,improve high power circulation and PHT,and the mechanism may be related to the increase of reticuloendothelial system function.