中華超聲影像學(xué)雜志(2000.06).pdf
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·臨床研究·
資助項(xiàng)目:廣東省醫(yī)學(xué)科研基金(B1999040)
作者單位:510080 廣州,中山醫(yī)科大學(xué)附屬第一醫(yī)院肝膽外科
肝硬化門脈高壓癥門脈血流動(dòng)力學(xué)變化及其
與食管靜脈曲張出血的關(guān)系
殷曉煜 呂明德 黃潔夫 梁力建
【摘要】 目的 探討肝硬化門脈高壓癥血流動(dòng)力學(xué)變化及其與食管靜脈曲張出血 ( EVB) 的關(guān)系。方法
運(yùn)用彩色多普勒流速剖面(CDVP)技術(shù)檢測 69 例肝硬化門脈高壓癥患者和 46 例正常人門靜脈主干( PT) 、右前
支(RAB)及脾靜脈(SV)的最大截面平均流速(CS 2Vmax) 、流量、瘀血指數(shù)(CI) 、剖面參數(shù) n 值和流量歷時(shí)變化曲
線 ,比較 EVB史陽性和陰性兩組間的血流動(dòng)力學(xué)差異 ,多元線性回歸分析與 EVB相關(guān)的因素。結(jié)果 肝硬化組
PT、 RAB的CS 2Vmax較正常組顯著減低 ,PT、 SV 的流量及 SV 與 PT流量比(SV/ PT)較正常組顯著增高 ,PT、 RAB
及 SV 的 CI均較正常組顯著增高 ,流量變化曲線在肝硬化組 RAB 恒定型增多 ,SV 周期變化型增多。肝硬化
EVB陽性組與陰性組相比 ,PT的 n值顯著低下 ,SV 流量、 SV/ PT及脾大小均顯著增高 ,多元線性回歸分析發(fā)現(xiàn)
PT的 n值和 SV/ PT是與 EVB相關(guān)的兩個(gè)獨(dú)立因素。結(jié)論 肝硬化時(shí)門靜脈系處于阻力增高和高動(dòng)力循環(huán)并
存狀態(tài) ,但在不同的血管有不同的表現(xiàn)側(cè)重 ,大體形成了血管愈趨向肝臟血流阻力愈大 ,愈遠(yuǎn)離肝臟高動(dòng)力循環(huán)
愈明顯的規(guī)律。SV 高動(dòng)力循環(huán)是門脈血流量增加的主要來源 ,是觸發(fā)出血的危險(xiǎn)因子。SV/ PT 流量比和 PT
的 n值可望成為 EVB的預(yù)測指標(biāo)。
【關(guān)鍵詞】 超聲檢查 ,多普勒 ,彩色;肝硬化;高血壓 ,門靜脈;血液動(dòng)力學(xué);食管和胃靜脈曲張
Change of portal hemodynamics in cirrhotics with portal hypertension and its implications in e sophageal variceal
bleeding YIN Xiaoyu , L U Mingde , HUA N G Jief u , et al . Department of Hepatobiliary S urgery , the Fi rst
A f f iliated Hospital of S un Yat2Sen University of Medical Sciences , Guangz hou 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 t runk ( PT) , right anterior
branch( RAB) and splenic vein ( SV) , including maximum cross 2sectional velocity (CS 2Vmax ) , flow volume and its
dynamic changes , congestion index(CI) and profile parameter n , were assessed in 69 cirrhotics withportal hypertension
and 46 normal volunteers using color Doppler velocity profile ( CDVP) . And Logistic regression was employed to
determine EVB2relating factors in cirrhotics. Re sults CS 2Vmax 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 pat tern , more RABs presented a flat pat tern and
more SVs had a periodically changed pat tern in cirrhotic group. In cirrhotic group , EVB ( + ) subgroup had a
significantly lower n value of PT and significantly greater SV flow volume , SV/ PT ratio and s pleen size compared with
EVB( - ) . Logistic regression revealed that n value of PT and SV/ PT ratio were two inde pendent EVB2related factors.
Conclusions In cirrhotics with portal hypertension , portal venous system coexists the elevated vascular resistance and
hyperdynamics , but with different predominance at different portion. It generally forms a regularity which the more
proximal to the liver , the higher the vascular resistance , and the more distal to the liver , the more remarkable the
hyperdynamics. SV hyperdynamics is the main source of increased portal blood flow and may t rigger occurrence of
EVB. SV/ PT ratio and n value of PT may become valuable parameters in predicting occurrence of EVB.
【Key words】 Ult rasonography ,Doppler ,color ;Liver cirrhosis ; Hypertension ,portal ; Hemodynamics ; Esophageal
and gast ric varices
食管靜脈曲張出血(esophageal variceal bleeding ,EVB)是肝硬化門脈高壓癥最危險(xiǎn)的并發(fā)癥 ,探討出血
的危險(xiǎn)因子有重要的臨床意義。關(guān)于 EVB 與門脈血
流動(dòng)力學(xué)改變的關(guān)系 ,目前尚有不同意見[124 ] ......
資助項(xiàng)目:廣東省醫(yī)學(xué)科研基金(B1999040)
作者單位:510080 廣州,中山醫(yī)科大學(xué)附屬第一醫(yī)院肝膽外科
肝硬化門脈高壓癥門脈血流動(dòng)力學(xué)變化及其
與食管靜脈曲張出血的關(guān)系
殷曉煜 呂明德 黃潔夫 梁力建
【摘要】 目的 探討肝硬化門脈高壓癥血流動(dòng)力學(xué)變化及其與食管靜脈曲張出血 ( EVB) 的關(guān)系。方法
運(yùn)用彩色多普勒流速剖面(CDVP)技術(shù)檢測 69 例肝硬化門脈高壓癥患者和 46 例正常人門靜脈主干( PT) 、右前
支(RAB)及脾靜脈(SV)的最大截面平均流速(CS 2Vmax) 、流量、瘀血指數(shù)(CI) 、剖面參數(shù) n 值和流量歷時(shí)變化曲
線 ,比較 EVB史陽性和陰性兩組間的血流動(dòng)力學(xué)差異 ,多元線性回歸分析與 EVB相關(guān)的因素。結(jié)果 肝硬化組
PT、 RAB的CS 2Vmax較正常組顯著減低 ,PT、 SV 的流量及 SV 與 PT流量比(SV/ PT)較正常組顯著增高 ,PT、 RAB
及 SV 的 CI均較正常組顯著增高 ,流量變化曲線在肝硬化組 RAB 恒定型增多 ,SV 周期變化型增多。肝硬化
EVB陽性組與陰性組相比 ,PT的 n值顯著低下 ,SV 流量、 SV/ PT及脾大小均顯著增高 ,多元線性回歸分析發(fā)現(xiàn)
PT的 n值和 SV/ PT是與 EVB相關(guān)的兩個(gè)獨(dú)立因素。結(jié)論 肝硬化時(shí)門靜脈系處于阻力增高和高動(dòng)力循環(huán)并
存狀態(tài) ,但在不同的血管有不同的表現(xiàn)側(cè)重 ,大體形成了血管愈趨向肝臟血流阻力愈大 ,愈遠(yuǎn)離肝臟高動(dòng)力循環(huán)
愈明顯的規(guī)律。SV 高動(dòng)力循環(huán)是門脈血流量增加的主要來源 ,是觸發(fā)出血的危險(xiǎn)因子。SV/ PT 流量比和 PT
的 n值可望成為 EVB的預(yù)測指標(biāo)。
【關(guān)鍵詞】 超聲檢查 ,多普勒 ,彩色;肝硬化;高血壓 ,門靜脈;血液動(dòng)力學(xué);食管和胃靜脈曲張
Change of portal hemodynamics in cirrhotics with portal hypertension and its implications in e sophageal variceal
bleeding YIN Xiaoyu , L U Mingde , HUA N G Jief u , et al . Department of Hepatobiliary S urgery , the Fi rst
A f f iliated Hospital of S un Yat2Sen University of Medical Sciences , Guangz hou 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 t runk ( PT) , right anterior
branch( RAB) and splenic vein ( SV) , including maximum cross 2sectional velocity (CS 2Vmax ) , flow volume and its
dynamic changes , congestion index(CI) and profile parameter n , were assessed in 69 cirrhotics withportal hypertension
and 46 normal volunteers using color Doppler velocity profile ( CDVP) . And Logistic regression was employed to
determine EVB2relating factors in cirrhotics. Re sults CS 2Vmax 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 pat tern , more RABs presented a flat pat tern and
more SVs had a periodically changed pat tern in cirrhotic group. In cirrhotic group , EVB ( + ) subgroup had a
significantly lower n value of PT and significantly greater SV flow volume , SV/ PT ratio and s pleen size compared with
EVB( - ) . Logistic regression revealed that n value of PT and SV/ PT ratio were two inde pendent EVB2related factors.
Conclusions In cirrhotics with portal hypertension , portal venous system coexists the elevated vascular resistance and
hyperdynamics , but with different predominance at different portion. It generally forms a regularity which the more
proximal to the liver , the higher the vascular resistance , and the more distal to the liver , the more remarkable the
hyperdynamics. SV hyperdynamics is the main source of increased portal blood flow and may t rigger occurrence of
EVB. SV/ PT ratio and n value of PT may become valuable parameters in predicting occurrence of EVB.
【Key words】 Ult rasonography ,Doppler ,color ;Liver cirrhosis ; Hypertension ,portal ; Hemodynamics ; Esophageal
and gast ric varices
食管靜脈曲張出血(esophageal variceal bleeding ,EVB)是肝硬化門脈高壓癥最危險(xiǎn)的并發(fā)癥 ,探討出血
的危險(xiǎn)因子有重要的臨床意義。關(guān)于 EVB 與門脈血
流動(dòng)力學(xué)改變的關(guān)系 ,目前尚有不同意見[124 ] ......
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