腹部B超在肝硬化门脉高血压诊断中的应用

目的:探讨腹部B超对肝硬化门脉高血压患者诊断的临床价值。方法:选取肝硬化门脉高血压患者80例作为观察组,同时随机选取健康人50例作为对照组,分别给予腹部B超检查。结果:观察组门静脉内径、脾静脉内径、Qsv/Qpv值均高于对照组,差异具有统计学意义(P<0.05)。结论:腹部B超可准确反映肝硬化门脉高血压患者的门静脉和脾静脉情况,具有重要的临床诊断价值。

肝硬化伴高血压患者采用开放饮食与限盐饮食对病情改善的比较

目的探讨肝硬化伴高血压患者采用开放饮食与限盐饮食对病情的改善作用。方法随机选取我院2012年5月至2015年5月收治的80例肝硬化伴高血压患者,依据饮食方式分为开放饮食组(n=40)和限盐饮食组(n=40)。开放饮食组患者不特殊限制氯化钠摄入量,限盐饮食组患者的氯化钠摄入量在80mg/d以下。然后对两组患者的肝功能及血压进行统计学分析。结果开放饮食组患者的ALT、AST、ALP水平均显著低于限盐饮食组(P<0.05),Alb水平显著高于限盐饮食组(P<0.05),舒张压(DBP)和收缩压(SBP)水平均显著高于限盐饮食组(P<0.05)。结论开放饮食较限盐饮食更能有效改善肝硬化伴高血压患者的肝功能,而限盐饮食较开放饮食更能有效改善患者的高血压,二者各有利弊。

精细化护理在肝硬化合并高血压患者的应用价值研究

目的分析精细化护理在肝硬化合并高血压患者的临床效果。方法随机选取2018年12月至2019年12月本院收治的78例肝硬化合并高血压患者为研究对象,采用随机数字表法进行分组。常规组39例,实施常规护理;观察组39例,实施精细化护理。对比两组患者护理前后的血压情况以及生活质量评分。结果护理后,两组患者的收缩压以及舒张压均有所降低,且观察组低于常规组(P<0.05);护理后,两组患者的生活质量评分均高于护理前,且观察组高于常规组(P<0.05)。结论给予肝硬化合并高血压患者精细化护理,能够有效控制患者血压水平,改善患者生活质量,值得推广。

限盐饮食对肝硬化患者高血压病情的影响

目的研究开放饮食与限盐饮食对肝硬化伴高血压病情的影响。方法选取2018年4月至2019年2月我院收治的124例肝硬化伴高血压患者作为研究对象,按照是否限盐饮食分为观察组和对照组,观察组62例,对照组62例,对照组开放饮食,观察组限盐饮食,对比两组的肝功能评分、血压状况以及病情恶化发生率和并发证发生率。结果观察组与对照组比较,观察组的各项肝功能评分较高,血压较稳定,病情恶化发生率低,并发症发生率低,各项对比差异有统计学意义(P<0.05)。结论限盐饮食对肝硬化伴高血压病情有明显的积极影响,有助于改善肝功能,稳定血压,降低病情恶化的发生率和并发症的发生率,在实际临床中具有较高的意义,在临床的实用价值显著,因此应该广泛地推荐运用。

天麻钩藤饮加减联合西药治疗肝硬化合并高血压的临床研究

目的观察天麻钩藤饮加减联合西药治疗肝硬化合并高血压的疗效及生存质量。方法收集在阜新市传染病医院肝病科治疗的肝硬化合并高血压患者160例,分为对照组80例和中西医结合治疗组80例。两组患者均进行抗病毒、抗纤维化等常规西医治疗。中西医结合治疗组在常规西医治疗的基础上给予中药治疗,观察患者治疗前后静脉血中亮氨酸氨基肽酶(LAP)、低密度脂蛋白胆固醇(LDL-C)水平变化情况并比较检测值的差异,对两组患者生存质量进行评估。结果两组患者治疗后LAP明显降低(P<0.05),组间比较差异明显(P<0.05);两组患者治疗后LDL-C明显降低(P<0.05),组间比较差异明显(P<0.05)。两组患者治疗后相比,中西医结合组焦虑抑郁水平改善明显,差异有统计学意义。中西医结合治疗组生活质量评分明显优于对照组,两组比较差异明显(P<0.05)。结论天麻钩藤饮加减联合西药治疗肝硬化合并高血压的疗效较好,能够改善患者的生存质量,调整患者的心理状态,值得临床推广应用。

2例肝硬化伴高血压患者临床用药的药学监护

目的:分析肝硬化伴高血压病患者临床用药的药学监护要点。方法:结合药师参与药学监护的2例肝硬化伴高血压病患者的典型病例,提醒临床医生应注意观察药物不良反应及药物相互间的作用,提出用药建议,经评估医生采纳药师建议,并取得较好的临床疗效。结果:临床药师根据上述2例患者的临床症状,提出肝硬化伴高血压病患者的药学监护要点,采用抗高血压药与糖皮质激素联用时要注意糖皮质激素对血压的影响,另还应注意抗菌药物对血压的间接影响;采用保肝药物时,应避免与甘草酸制剂联用,以避免升高血糖值等,实施药学监护后患者血压及肝功能指标恢复正常,病情得到缓解。结论:肝硬化伴高血压患者的药学监护,应将抗血压药物、保肝药物的用药监护作为重点,密切关注各种药物治疗后对患者血压及肝功能指标的影响。

肝硬化腹腔积液病人的临床护理体会

[目的]通过对肝硬化腹腔积液妊娠高血压综合征病人护理难点的剖析,提出相应对策。[方法]随机抽取上海市某医院肝硬化科住院病人116例,调查其存在的护理问题。采用深入访谈与临床观察相结合的方式,通过为期21 d的资料收集,最终提出相应的护理对策。[结果]针对肝硬化腹腔积液妊娠高血压综合征病人普遍存在的7个维度护理难点,进行针对性的护理。[结论]针对肝硬化腹腔积液妊娠高血压综合征病人的护理难点,所提出的护理对策能有效帮助低年资护士解决护理问题,提高工作效率及工作质量。

肝硬化门静脉高压症脾切除术后血小板数量变化分析

目的:探讨肝硬化门脉高压症脾切除术后血小板数量变化的临床意义。方法:统计分析153例肝硬化伴脾大脾亢患者脾切除术前后(肝硬化组)血小板(PLT)计数和肝功能,观察血小板变化趋势,比较脾切除术前后血小板变化和肝功能变化的关系,同时与脾外伤组对比。结果:肝硬化组术后多数血小板升高,部分不升高,甚至降低,并与肝功能相关。肝硬化组较外伤组手术前后血小板变化不明显。结论:肝硬化血小板减少数民的原因除与脾肿大等有关外,还可能与肝脏功能变化有关。

分析影响肝硬化门脉高压患者胃肠道出血的相关危险因素

目的研究分析影响肝硬化门脉高压患者胃肠道出血的相关危险因素。方法选取2018年1月至2019年1月我院收治的120例肝硬化门脉高压患者,将所有患者按照出血与未出血的标准分为对照组(60例,胃肠道出血)和研究组(60例,肠胃道未出血),比较两组患者的肺功能Child-Pugh分级、门静脉内径、脾静脉内径、食管静脉曲张、胃底静脉曲张、冠状静脉怒张、红色征。结果对照组的门静脉内径、脾静脉内径明显大于研究组,差异具有统计学意义(P<0.05),研究组的肺功能Child-Pugh分级、食管静脉曲张、胃底静脉曲张、冠状静脉怒张、红色征明显优于对照组,差异具有统计学意义(P<0.05)。结论门静脉内径、脾静脉内径、肺功能Child-Pugh分级、食管静脉曲张、胃底静脉曲张、冠状静脉怒张、红色征都是影响肝硬化门脉高压患者胃肠道出血的因素。

脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压合并脾动脉盗血综合征

目的研究脾切除联合贲门周围血管离断术治疗肝硬化门静脉高压合并脾动脉盗血综合征的临床治疗效果.方法此次研究将选择我院收治的67例肝硬化静脉高血压合并脾动脉盗血综合征的患者作为本次的研究对象,所有患者均为2018年4月~2019年4月于我院接受治疗的患者,采用掷骰子的方式将患者随机分为两组.观察组34例患者,对照组33例患者.对照组给予开腹脾切除术,观察组病患均为采用完全腹腔镜下巨脾切除术联合贲门周围血管离断术进行治疗的,观察两组患者经过治疗后的病情改善情况与手术并发症的发生情况等.结果观察组的术后恢复情况明显优于对照组.结论通过脾切除联合贲门周围血管离断术对肝硬化门静脉高血压合并脾动脉盗血综合征进行治疗,能够帮助患者恢复身体健康,值得应用与推广.

介入断流术治疗肝硬化门脉高压合并上消化道出血效果探讨

目的：研究介入断流术治疗肝硬化门脉高压合并上消化道出血的效果。方法：选取我院2012年1月-2014年10月间诊治的肝硬化门脉高血压合并上消化道出血患者110例，将其随机分为观察组和对照组各55例，对观察组患者采用联合断流术治疗，对对照组患者进行中西医结合治疗，对比观察2组患者的临床治疗效果及不良反应。结果：观察组患者的总有效率为92．73％，对照组患者的总有效率为78．18％，观察组明显高于对照组，差异具有统计学意义（P〈0．05）；在不良反应发生率方面，观察组患者为5．45％，对照纽患者为12．73％，观察纽明显低于对照组，差异具有统计学意义（P〈0．05）。结论：采用联合断流术治疗肝硬化门脉高血压合并上消化道出血不仅可以提高临床治疗效果，而且还能降低并发症的发生率，值得临床推广使用。

门静脉高压症的围手术期处理

目的 :强调合理的门静脉高压症围手术期处理的重要性。方法 :回顾总结 4 0 0余例肝硬化门静脉高压症术前的各种检查方法、药物治疗、术式选择、手术操作要点以及恰当的术后处理。结果 :本组病例在合理的门静脉高压症围手术期处理后 ,手术经过顺利 ,术后恢复良好。结论 :最佳的围手术期处理可保证手术的安全性 。

Correlation of transient elastography with hepatic venous pressure gradient in patients with cirrhotic portal hypertension: A study of 326 patients from India

AIMTo study the diagnostic accuracy of transient elastography (TE) for detecting clinically significant portal hypertension (CSPH) in Indian patients with cirrhotic portal hypertension.METHODSThis retrospective study was conducted at the Institute of Liver, Gastroenterology, and Pancreatico-Biliary Sciences, Sir Ganga Ram Hospital, New Delhi, on consecutive patients with cirrhosis greater than 15 years of age who underwent hepatic venous pressure gradient (HVPG) and TE from July 2011 to May 2016. Correlation between HVPG and TE was analyzed using the Spearman&#x02019;s correlation test. Receiver operating characteristic (ROC) curves were prepared for determining the utility of TE in predicting various stages of portal hypertension. The best cut-off value of TE for the diagnosis of CSPH was obtained using the Youden index.RESULTSThe study included 326 patients [median age 52 (range 16-90) years; 81% males]. The most common etiology of cirrhosis was cryptogenic (45%) followed by alcohol (34%). The median HVPG was 16.0 (range 1.5 to 30.5) mmHg. Eighty-five percent of patients had CSPH. A significant positive correlation was noted between TE and HVPG (rho 0.361, P &#x0003c; 0.001). The area under ROC curve for TE in predicting CSPH was 0.740 (95%CI: 0.662-0.818) (P &#x0003c; 0.01). A cut-off value of TE of 21.6 kPa best predicted CSPH with a positive predictive value (PPV) of 93%.CONCLUSIONTE has a fair positive correlation with HVPG; thus, TE can be used as a non-invasive modality to assess the degree of portal hypertension. A cut-off TE value of 21.6 kPa identifies CSPH with a PPV of 93%.

Effect of increased hepatic platelet activating factor and its receptor portal hypertension in CCl_4-induced liver cirrhosis

AIM： To evaluate the changes in hepatic platelet activating factor （PAF） and its receptors and their effect on portal pressure of cirrhotic rats induced by CCh. METHODS： A model of liver cirrhosis was replicated in rats by intra-peritoneal injection of CCh for 8 wk. We determined the effect of hepatic PAF and its receptor level on portal and arterial pressure by EIA, saturation binding and RT-PCR technique. RESULTS： Compared to control rats, cirrhotic rats had higher hepatic PAF levels and output as well as higher plasma PAF levels （P〈0.01, P〈0.01, P〈0.05, respectively）. Both hepatic PAF receptor mRNA levels and PAF binding were nearly 3-fold greater in cirrhotic rats （P〈0.01）. Portal injection of PAF （1 g/kg WT） increased the portal pressure by 22% and 33% in control and cirrhotic rats, respectively. In contrast, the arterial pressure was decreased in the both groups （54% in control rats and 42% in cirrhotic rats）. Injection of the PAF antagonist BN52021 （5 mg/kg WT） decreased the portal pressure by 16% in cirrhotic rats but had no effect in the control rats. CONCLUSION： The upregulation of the PAF system contributes to hepatic hemodynamic and metabolic abnormalities in drrhosis, and the increased release of PAF into the circulation has impacts on the systemic hemodynamics.

Management of digestive bleeding related to portal hypertension in cirrhotic patients:A French multicenter cross-sectional practice survey

AIM: To investigate the conformity of management practices of gastrointestinal hemorrhage in cirrhotic patients with relevant guidelines. METHODS: A questionnaire on the management of digestive bleeding was completed for all consecutive cirrhotic patients admitted to 31 French hospitals. RESULTS: One hundred and twenty-six bleeding events were recorded. It was the first bleeding episode in 79 patients (63%), of whom 40 (51%) had a prior diagnosis of cirrhosis and 25 (32%) had previously undergone an endoscopy. The bleeding episode was a recurrence in 46 patients (37%). The median time between onset and admission was 4 h, but exceeded 12 h in 42% of cases. There was an agreement between centers forearly vasoactive drug administration (87% of cases), association with ligation (42%) more often than sclerosis (21%) at initial endoscopy, and antibiotic prophylaxis (64%). By contrast, prescription of beta-blockade alone or in combination (0 to 100%, P = 0.003) for secondary prophylaxis and lactulose (26% to 86%, P = 0.04), differed among centers. CONCLUSION: In French hospitals, management of bleeding related to portal hypertension in cirrhotic patients is generally in keeping with the consensus. Broad variability still remains concerning beta-blockade use for secondary prophylaxis. Screening for esophageal varices, the use of antibiotic prophylaxis and patients information need to be improved.

Stability of cirrhotic systemic hemodynamics ensures sufficient splanchnic blood flow after living-donor liver transplantation in adult recipients with liver cirrhosis

AIM： To investigate the correlation between systemic hemodynamics and splanchnic circulation in recipients with cirrhosis undergoing living-donor liver transplantation （LDLT）, and to clarify how systemic hemodynamics impact on local graft circulation after LDLT.METHODS： Systemic hemodynamics, indocyanine green （ICG） elimination rate （K,cG） and splanchnic circulation were simultaneously and non-invasively investigated by pulse dye densitometry （PDD） and ultrasound. Accurate estimators of optimal systemic hyperdynamics after LDLT [i.e., balance of cardiac output （CO） to blood volume （BV） and mean transit time （MTT）, defined as the time required for half the administered ICG to pass through an attached PDD sensor in the first circulation] were also measured. Thirty recipients with cirrhosis were divided into two groups based on clinical outcomes corresponding to postoperative graft function.RESULTS： Cirrhotic systemic hyperdynamics characterized by high CO, expanded BV and low total peripheral resistance （TPR） were observed before LDLT. TPR reflecting cirrhotic vascular alterations was slowly restored after LDLT in both groups. Although no significant temporal differences in TPR were detected between the two groups, CO/BV and M＇IT differed significantly. Recipients with good outcomes showed persistent cirrhotic systemic hyperdynamics after LDLT, whereas recipients with poor outcomes presented with unstable cirrhotic systemic hyperdynamics and severely decreased KICG. Systemic hyperdynamic disorders after LDLT impacted on portal venous flow but not hepatic arterial flow.CONCLUSION： We conclude that subtle systemic hyperdynamics disorders impact on splanchnic circulation, and that an imbalance between CO and BV decreases portal venous flow, which results in critical outcomes.

A randomized controlled trial of laparoscopic versus open cholecystectomy in patients with cirrhotic portal hypertension

AIM: To evaluate the characters, risks and benefits of laparoscopic cholecystectomy (LC) in cirrhotic portal hypertension (CPH) patients.METHODS: Altogether 80 patients with symptomatic gallbladder disease and CPH, including 41 Child class A,32 Child class B and 7 Child class C, were randomly divided into open cholecystectomy (OC) group (38 patients) and LC group (42 patients). The cohorts were well-matched for number, age, sex, Child classification and types of disease.Data of the two groups were collected and analyzed.RESULTS: In LC group, LC was successfully performed in 36 cases, and 2 patients were converted to OC for difficulty in managing bleeding under laparoscope and dense adhesion of Calot's triangle. The rate of conversion was 5.3%. The surgical duration was 62.6±15.2 min. The operative blood loss was 75.5±15.5 mL. The time to resume diet was 18.3±6.5 h. Seven postoperative complications occurred in five patients (13.2%). All patients were dismissed after an average of 4.6±2.4 d. In OC group, the operation time was 60.5±17.5 min. The operative blood loss was 112.5±23.5 mL. The time to resume diet was 44.2±10.5 h.Fifteen postoperative complications occurred in 12patients (30.0%). All patients were dismissed after an average of 7.5±3.5 d. There was no significant difference in operation time between OC and LC group. But LC offered several advantages over OC, including fewer blood loss and lower postoperative complication rate, shorter time to resume diet and shorter length of hospitalization in patients with CPH.CONCLUSION: Though LC for patients with CPH is difficult, it is feasible, relatively safe, and superior to OC.It is important to know the technical characters of the operation, and pay more attention to the meticulous perioperative managements.

Portal hypertensive colopathy in patients with liver cirrhosis

AIM: In patients with liver cirrhosis and portal hypertension, portal hypertensive colopathy is thought to be an important cause of lower gastrointestinal hemorrhage. In this study, we evaluated the prevalence of colonic mucosal changes in patients with liver cirrhosis and its clinical significance. METHODS: We evaluated the colonoscopic findings and liver function of 47 patients with liver cirrhosis over a 6-year period. The main cause of liver cirrhosis was post-viral hepatitis (68%) related to hepatitis B (6%) or C (62%) infection. All patients underwent upper gastrointestinal endoscopy to examine the presence of esophageal varices, cardiac varices, and congestive gastropathy, as well as a full colonoscopy to observe changes in colonic mucosa. Portal hypertensive colopathy was defined endoscopically in patients with vascular ectasia, redness, and blue vein. Vascular ectasia was classified into two types: type 1, solitary vascular ectasia; and type 2, diffuse vascular ectasia. RESULTS: Overall portal hypertensive colopathy was present in 31 patients (66%), including solitary vascular ectasia in 17 patients (36%), diffuse vascular ectasia in 20 patients (42%), redness in 10 patients (21%) and blue vein in 6 patients (12%). As the Child-Pugh class increased in severity, the prevalence of portal hypertensive colopathy rose. Child-Pugh class B and C were significantly associated with portal hypertensive colopathy. Portal hypertensive gastropathy, esophageal varices, ascites and hepatocellular carcinoma were not related to occurrence of portal hypertensive colopathy. Platelet count was significantly associated with portal hypertensive colopathy, but prothrombin time, serum albumin level, total bilirubin level and serum ALT level were not related to occurrence of portal hypertensive colopathy. CONCLUSION: As the Child-Pugh class worsens and platelet count decreases, the prevalence of portal hypertensive colopathy increases in patients with liver cirrhosis. A colonoscopic examination in patients with liver cirrhosis is indicated, especially those with worsening Child-Pugh class and/or decreasing platelet count, to prevent complications such as lower gastrointestinal bleeding.

To screen or not to screen? Celiac antibodies in liver diseases

Celiac disease(CD) is a systemic immune-mediated disorder triggered by dietary gluten in genetically predisposed individuals. The typical symptoms are anemia, diarrhea, fatigue, weight loss, and abdominal pain. CD has been reported in patients with primary sclerosing cholangitis, primary biliary cholangitis, autoimmune hepatitis, aminotransferase elevations, nonalcoholic fatty liver disease, hepatitis B, hepatitis C, portal hypertension and liver cirrhosis. We evaluate recommendations for active screening for CD in patients with liver diseases, and the effect of a gluten-free diet in these different settings. Active screening for CD is recommended in patients with liver diseases, particularly in those with autoimmune disorders, steatosis in the absence of metabolic syndrome, noncirrhotic intrahepatic portal hypertension, cryptogenic cirrhosis, and in the context of liver transplantation. In hepatitis C, diagnosis of CD can be important as a relative contraindication to interferon use. Gluten-free diet ameliorates the symptoms associated with CD; however, the associated liver disease may improve, remain the same, or progress.