目的探讨门静脉高压症分流、断流术治疗前后肝血流和血清总胆汁酸(sTBA)变化的临床意义。方法28例门静脉高压症患者分A、B 2组,A组行脾切除加局限性分流术,B组行脾切除加贲门周围血管离断术。分别在术前及术后1周测定2组患者外周sTBA;...目的探讨门静脉高压症分流、断流术治疗前后肝血流和血清总胆汁酸(sTBA)变化的临床意义。方法28例门静脉高压症患者分A、B 2组,A组行脾切除加局限性分流术,B组行脾切除加贲门周围血管离断术。分别在术前及术后1周测定2组患者外周sTBA;应用彩色多普勒及改进的D山-梨醇肝清除率法分别对2组患者进行肝总血流量(THF)和肝功能性血流量(FHF)的检测。结果术前2组sTBA较正常值均明显升高,但组间无显著差异(P>0.05);术后1周A组比术前升高(P<0.05),B组较术前下降(P<0.01),A组较B组显著升高(P<0.01)。A组治疗1周后FHF与术前比较差异有显著意义(529±109 vs 833±166,P<0.01),肝功能Ch ild-Pugh评分也有显著变化(8.4±1.9 vs 7.1±1.9,P<0.05);B组术后1周FHF及Ch ild-Pugh评分与术前比较差异均无显著性。结论门脉分流术后sTBA明显升高,间接反映吻合口分流情况,在断流术后sTBA明显降低,间接反映贲门周围血管离断是否完全;应用彩色多普勒结合改进的D山-梨醇肝清除率法测量THF与FHF是可行的,分流术对改善肝功能分级和FHF有较大意义。展开更多
AIM： To investigate the usefulness of direct hemoperfusion with a polymyxin B-immobilized fiber column （DHP-PMX therapy） for warm hepatic ischemia-reperfusion （I/R） injury after total hepatic vascular exclusion ...AIM： To investigate the usefulness of direct hemoperfusion with a polymyxin B-immobilized fiber column （DHP-PMX therapy） for warm hepatic ischemia-reperfusion （I/R） injury after total hepatic vascular exclusion （THVE） using a porcine model. METHODS： Eleven Mexican hairless pigs weighing 22-38 kg were subjected to THVE for 120 min and then observed for 360 min. The animals were divided into two groups randomly： the DHP-PMX group （n = 5） underwent DHP-PMX at a flow rate of 80 mL/min for 220 min （beginning 10 rain before reperfusion）, while the control group did not （n = 6）. The rate pressure product （RPP）： heart rate x end-systolic arterial blood pressure, hepatic tissue blood flow （HTBF）, portal vein blood flow （PVBF）, and serum aspartate aminotransferase （AST） levels were compared between the two groups. RESULTS： RPP and HTBF were significantly （P 〈 0.05） higher in the DHP-PMX group than in the control group 240 and 360 min after reperfusion. PVBF in the DHP-PMX group was maintained at about 70% of the flow before ischemia and differed significantly （P 〈 0.05） compared to the control group 360 min after reperfusion. The serum AST increased gradually after reperfusion in both groups, but the AST was significantly （P 〈 0.05） lower in the DHP-PMX group 360 min after reperfusion. CONCLUSION： DHP-PMX therapy reduced the hepatic warm I/R injury caused by THVE in a porcine model.展开更多
文摘目的探讨门静脉高压症分流、断流术治疗前后肝血流和血清总胆汁酸(sTBA)变化的临床意义。方法28例门静脉高压症患者分A、B 2组,A组行脾切除加局限性分流术,B组行脾切除加贲门周围血管离断术。分别在术前及术后1周测定2组患者外周sTBA;应用彩色多普勒及改进的D山-梨醇肝清除率法分别对2组患者进行肝总血流量(THF)和肝功能性血流量(FHF)的检测。结果术前2组sTBA较正常值均明显升高,但组间无显著差异(P>0.05);术后1周A组比术前升高(P<0.05),B组较术前下降(P<0.01),A组较B组显著升高(P<0.01)。A组治疗1周后FHF与术前比较差异有显著意义(529±109 vs 833±166,P<0.01),肝功能Ch ild-Pugh评分也有显著变化(8.4±1.9 vs 7.1±1.9,P<0.05);B组术后1周FHF及Ch ild-Pugh评分与术前比较差异均无显著性。结论门脉分流术后sTBA明显升高,间接反映吻合口分流情况,在断流术后sTBA明显降低,间接反映贲门周围血管离断是否完全;应用彩色多普勒结合改进的D山-梨醇肝清除率法测量THF与FHF是可行的,分流术对改善肝功能分级和FHF有较大意义。
文摘AIM： To investigate the usefulness of direct hemoperfusion with a polymyxin B-immobilized fiber column （DHP-PMX therapy） for warm hepatic ischemia-reperfusion （I/R） injury after total hepatic vascular exclusion （THVE） using a porcine model. METHODS： Eleven Mexican hairless pigs weighing 22-38 kg were subjected to THVE for 120 min and then observed for 360 min. The animals were divided into two groups randomly： the DHP-PMX group （n = 5） underwent DHP-PMX at a flow rate of 80 mL/min for 220 min （beginning 10 rain before reperfusion）, while the control group did not （n = 6）. The rate pressure product （RPP）： heart rate x end-systolic arterial blood pressure, hepatic tissue blood flow （HTBF）, portal vein blood flow （PVBF）, and serum aspartate aminotransferase （AST） levels were compared between the two groups. RESULTS： RPP and HTBF were significantly （P 〈 0.05） higher in the DHP-PMX group than in the control group 240 and 360 min after reperfusion. PVBF in the DHP-PMX group was maintained at about 70% of the flow before ischemia and differed significantly （P 〈 0.05） compared to the control group 360 min after reperfusion. The serum AST increased gradually after reperfusion in both groups, but the AST was significantly （P 〈 0.05） lower in the DHP-PMX group 360 min after reperfusion. CONCLUSION： DHP-PMX therapy reduced the hepatic warm I/R injury caused by THVE in a porcine model.
