肝硬化患者门静脉系统血流动力学变化及其临床意义

Changes of portal hemodynamics in patients with liver cirrhosis and its clinical value

目的 :探讨肝硬化患者门静脉系统血流动力学的改变及其临床意义。 方法 :运用彩色多普勒超声仪检测4 0例肝硬化患者及 2 0例正常人的门静脉主干和脾静脉的最大截面直径、平均流速、流量及淤血指数 (CI)。 结果 :肝硬化组的门静脉直径 (PVD)、流量 (PVF)、淤血指数 (PVCI)和脾静脉直径 (SVD)、流量 (SVF)、淤血指数(SVCI)均显著大于正常对照组 (P <0 .0 1)。肝硬化组的门静脉流速 (PVV)、脾静脉流速 (SVV)显著小于正常对照组 (P <0 .0 1)。在肝硬化组内部 ,食管静脉曲张破裂出血EVB阳性者的PVD显著大于EVB阴性者 (P <0 .0 1)。PVCI及SVCI亦显著大于EVB阴性者 (P <0 .0 5 ) ,SVV显著小于阴性者 (P <0 .0 5 )。在肝功能不同的患者之间 ,Child PughC级患者的PVD及PVCI显著大于Child PughA级和B级患者 (P <0 .0 1) ,C级患者的PVV显著小于A级患者 (P <0 .0 5 )。 结论 :肝硬化门脉高压症患者门静脉系统的血流量增多 ,阻力增大 ,而且其程度受肝功能损害程度的影响 。

Objectives:To investigate the changes of portal hemodynamics in patients with liver cirrhosis and its clinical value. Methods:Forty patients with liver cirrhosis and twenty healthy volunteers as controls were involved in this study.The max diameters,mean flow velocity,flow rate and congestion index(CI) of the portal vein trunks(PV) and splenic veins(SV) were detected by Color Doppler Ultrasound in all subjects. Results:The PV diameters(PVD), PVT flow rate(PVF), PVCI and SV diameter(SVD),SV flow rate(SVF),SVCI were significantly highter in patients than in controls( P <0.01).The PV flow velocity(PVV) and SV flow velocity(SVV) were lower significantly in patietns than in controls( P < 0.01 ).If the patients were divided into two groups as EVB(+) and EVB(-),the EVB(+) group had significantly higher PVD( P <0.01),PVCI and SVCI( P <0.05) compared with the EBV(-) group.The SVV was significantly lower in EBV(+) group than in EVB(-) group( P <0.05).Among the patients with different hepatic function,the PVD and PVCI in Child Pugh C patients were signifcantly higher than in Child Pugh A and B patients( P <0.01).The PVV in Child Pugh C patients were significantly lower than in Child Pugh A patients( P <0.05). Conclusions:The flow rate and resistance of portal venous system in cirrhotic patients are increased.Furthermore,the changes of portal hemodynamics are influenced by hepatic function and are correlated to EVB.