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中华超声影像学杂志(2000.06).pdf
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    ·临床研究·

    资助项目:广东省医学科研基金(B1999040)

    作者单位:510080 广州,中山医科大学附属第一医院肝胆外科

    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

    殷晓煜 吕明德 黄洁夫 梁力建

    【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 2Vmax) 、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 2Vmax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 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

    食管静脉曲张出血(esophageal variceal bleeding ,EVB)是肝硬化门脉高压症最危险的并发症 ,探讨出血

    的危险因子有重要的临床意义。关于 EVB 与门脉血

    流动力学改变的关系 ,目前尚有不同意见[124 ] ......

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