彩色多普勒对肝硬化患者入肝血管的血流动力学研究

Color doppler study of fasting and postprandial hemodynamic changes in hepatic artery and portal vein in cirrhotic patients

目的:观测肝硬化患者入肝血管(肝右动脉,门静脉)餐前、后血流动力学改变,探讨其相互关系及其临床意义。方法:应用彩色多普勒超声分别测量33例肝硬化患者及50例正常成人餐前、后入肝血管的血流参数,包括门静脉主干的直径(D),血流速度(V),血流量(Q),肝右动脉的阻力指数(RI),搏动指数(PI)等,探讨其相互关系。结果:肝硬化患者餐前肝右动脉和门静脉各主要血流参数分别为:肝右动脉RI0.74±0.05,PI1.78±0.30,门静脉血流量为(1319.86±181.04)ml/min;餐后各主要血流参数分别为:肝右动脉RI0.80±0.04,PI2.20±0.47,门静脉血流量为(1566.37±230.58)ml/min。正常成人餐前、后肝右动脉和门静脉各主要血流参数亦变化显著。结论:餐前、后肝右动脉和门静脉各血流参数间的差异具有统计学意义(P<0.05),肝动脉和门静脉血流量存在彼消此长的关系,以维持入肝血流的相对衡定。测定血流动力学参数有助于肝硬化的鉴别诊断。

Objective:To investigate hemodynamic changes in the hepatic artery(HA)and portal vein(PV)before and after glucose ingestion and to probe their relationship.Methods :Color Doppler sonography was exploited to measure hemodynamic changes in the right hepatic artery and the main portal vein in re-sponse to glucose ingestion(200ml,50g)in50healthy subjects(28male,22female)aged19～42yr with an average of30yr and33cirrhotic patients (28male,22female)aged19～42yr with an average of30yr.Re sults:Doppler parameters of HA and PV were obtained,revealing that the resistance index(RI)and pul -satility in dex(PI)of the right hepatic artery and the velocity in the main portal vein significantly in creased from base line values after glucose ingestion.Sig nificant difference of Doppler parame ters of HA and PV was found between fasting and postprandial state(P<0.05).The state of reciprocal hemo dynamic re lation ship in HA and PV flow is to maintain constant hepatic perfusion.Conclusion:Doppler evaluation of hemo dynam ic changes may be useful in differentiating between patients with cirrhosis and healthy subjects.