肝硬化门脉高压症门脉血流动力学变化及其与食管静脉曲张出血的关系.docVIP

???? 肝硬化门脉高压症门脉血流动力学变化及其与食管静脉曲张出血的关系 ???? ????【摘要】　目的　探讨肝硬化门脉高压症血流动力学变化及其与食管静脉曲张出血 （EVB） 的关系。方法　运用彩色多普勒流速剖面(CDVP)技术检测69例肝硬化门脉高压症患者和46例正常人门静脉主干（PT）、右前支（RAB）及脾静脉（SV）的最大截面平均流速（CS-Vmax）、流量、瘀血指数（CI）、剖面参数n值和流量历时变化曲线，比较EVB史阳性和阴性两组间的血流动力学差异，多元线性回归分析与EVB相关的因素。结果　肝硬化组PT、RAB的CS-Vmax较正常组显著减低，PT、SV的流量及SV与PT流量比（SV/PT）较正常组显著增高，PT、RAB及SV的CI均较正常组显著增高，流量变化曲线在肝硬化组RAB恒定型增多，SV周期变化型增多。肝硬化EVB阳性组与阴性组相比，PT的n值显著低下，SV流量、SV/PT及脾大小均显著增高，多元线性回归分析发现PT的n值和SV/PT是与EVB相关的两个独立因素。结论　肝硬化时门静脉系处于阻力增高和高动力循环并存状态，但在不同的血管有不同的表现侧重，大体形成了血管愈趋向肝脏血流阻力愈大，愈远离肝脏高动力循环愈明显的规律。SV高动力循环是门脉血流量增加的主要来源，是触发出血的危险因子。SV/PT流量比和PT的n值可望成为EVB的预测指标。　　【关键词】　超声检查,多普勒,彩色;肝硬化;高血压,门静脉;血液动力学;食管和胃静脉曲张 Change of portal hemodynamics in cirrhotics with portal hypertension and its implications in esophageal variceal bleeding YIN Xiaoyu, LU Mingde, HUANG Jiefu, et al.（Department of Hepatobiliary Surgery,the First Affiliated Hospital of Sun Yat-Sen University of Medical Sciences, Guangzhou 510080,China） 　　【Abstract】　Objective　To investigate the portal hemodynamics and its correlation with esophageal variceal bleeding (EVB) in cirrhotics with portal hypertension.Methods　Hemodynamics of portal trunk(PT), right anterior branch(RAB) and splenic vein(SV), including maximum cross-sectional velocity(CS-Vmax), flow volume and its dynamic changes, congestion index(CI) and profile parameter n, were assessed in 69 cirrhotics with portal hypertension and 46 normal volunteers using color Doppler velocity profile(CDVP). And Logistic regression was employed to determine EVB-relating factors in cirrhotics. Results　CS-Vmax of PT and RAB was significantly lower in cirrhotic group than in normal group; PT and SV flow volume and the ratio of SV to PT flow volume(SV/PT) were significantly higher in cirrhotic group compared with those of normal group; CI of PT,RAB and SV was significantly higher in cirrhotic group than in normal group. With respect to flow pattern, more RABs presented a flat pattern and more SVs had a periodically changed pattern in cirrhotic grou