肝硬化门静脉高压伴脾亢患者血流动力学变化的初步研究

发布时间：2018-04-02 11:20

本文选题：肝硬化　切入点：门静脉高压　出处：《遵义医学院》2014年硕士论文

【摘要】：目的：探讨肝硬化门静脉高压与肝动脉、脾动脉间的血流动力学关系，为肝化门静脉高压患者探索新的诊疗方法提供依据；观察肝硬化门静脉高压伴脾亢患者部分性脾动脉栓塞（PSE）术前及术后1周肝动脉、脾动脉及门静脉系统血流动力学变化，探讨PSE对肝硬化门静脉高压治疗的影响。方法：42例肝硬化门静脉高压伴脾亢患者接受PSE治疗，利用彩色多普勒超声(CDU)分别于PSE术前及术后1周对肝动脉、脾动脉、脾静脉及门静脉血流动力学指标进行检测，主要检测指标包括：肝动脉、脾动脉、脾静脉及门静脉血管内径、血流速度、血流量和血管阻力。另选取88例健康对照组，同样采用彩色多普勒超声检测肝动脉、脾动脉、脾静脉及门静脉血流动力学相应指标。观察肝硬化门静脉高压伴脾亢患者PSE术前与术后1周肝动脉、脾动脉及门静脉血流动力学指标的变化，分析PSE对门静脉血流的影响。结果:门静脉高压伴脾亢组患者PSE术前脾动脉、脾静脉及门静脉内径分别为（5.18±0.85）mm、（10.61±2.61）mm、（14.21±1.74）mm，平均血流速度分别为（54.96±12.86）cm/s、（19.14±6.33）cm/s、（17.31±4.65）cm/s，，平均血流量分别为（708.29±286.10）ml/min、（1156.4±82.56）ml/min、（1642.40±57.88）ml/min；对照组脾动脉、脾静脉及门静脉内径分别为（3.56±0.44）mm、（6.00±0.60）mm、（10.60±0.97mm），平均血流速度分别为（37.43±13.14） cm/s、（18.01±3.42）cm/s、（17.91±3.51）cm/s，平均血流量分别为（231.65±114.21）ml/min、（308.34±82.12）ml/min、（959.97±261.23）ml/min。上述指标两组比较，P0．05，差异有统计学意义，门静脉高压伴脾亢组观察指标均高于健康对照组。PSE术前肝动脉血流量（111.52±48.06）ml/min较对照组（232.85±109.66）ml/min减少，P0．05，差异有统计学意义；部分性脾动脉栓塞后1周，各项指标检测值分别为：肝动脉血流量（382.57±314.53）ml/min，脾动脉血流量（486.56±135.68）ml/min，脾静脉血流量（1026.62±43.59）ml/min，门静脉血流量（1376.45±44.17）ml/min，与术前比较肝动脉血流量增加，其余指标均较术前减少，P0．05，差异有统计学意义。结论：肝硬化门静脉高压脾亢患者脾动脉、脾静脉血管内径增粗，循环血量加大，是门静脉高压形成血流注入的动力因素，脾栓塞可减少脾循环血量，从而降低门静脉压力，同时可增加肝脏动脉血供。
[Abstract]:Objective: to explore the hemodynamic relationship between portal hypertension and hepatic artery and splenic artery in cirrhotic patients, so as to provide basis for the diagnosis and treatment of hepatic portal hypertension. To observe the hemodynamic changes of hepatic artery, splenic artery and portal vein system before and after partial splenic artery embolization (PSE) in patients with cirrhotic portal hypertension and hypersplenism, and to investigate the effect of PSE on the treatment of cirrhosis and portal hypertension. Methods 42 patients with portal hypertension associated with hypersplenism were treated with PSE. The hemodynamic indexes of hepatic artery, splenic artery, splenic vein and portal vein were measured before and 1 week after PSE. The main parameters included: diameter of hepatic artery, splenic artery, splenic vein and portal vein, blood flow velocity, blood flow and vascular resistance. To observe the changes of hepatic artery, splenic artery and portal vein hemodynamics in patients with cirrhosis and portal hypertension with hypersplenism before and after PSE, and to analyze the influence of PSE on portal vein blood flow. Results: before PSE, the diameter of splenic artery, splenic vein and portal vein in portal hypertension with hypersplenism group were 5.18 卤0.85 卤0.85 卤2.61 卤2.61 卤2.61 卤1.74 mm, respectively, and the mean blood flow velocity was 54.96 卤12.86 卤12.86 卤19.14 卤6.33 cm / r 路min ~ (-1) 路min ~ (-1) respectively, and the mean blood flow was 1.708.29 卤286.10 ml / min, 1156.4 卤82.56 ml / min / min, 1642.40 卤57.88 ml / min, respectively; in the control group, the mean blood flow was 1142.40 卤57.88 ml / min; in the control group, the mean blood flow was 115.29 卤286.10ml / min and 1642.40 卤57.88ml / min, respectively. The internal diameters of splenic vein and portal vein were 6.00 卤0.60 卤0.60 卤0.97 卤10.60 卤0.97 mm, respectively. The mean blood flow velocity was 37.43 卤13.14) cm / s, respectively 18.01 卤3.42 卤3.42 卤17.91 卤3.51 cm / s, and the mean blood flow was 231.65 卤114.21 / ml / min, 308.34 卤82.12ml / min, 959.97 卤261.23ml / min, respectively. The difference between the two groups was statistically significant. The observed indexes of portal hypertension with hypersplenism were significantly higher than those of the control group (111.52 卤48.06)ml/min) and the control group (232.85 卤109.66)ml/min) (P 0.05), the difference was statistically significant (P 0.05), 1 week after partial splenic artery embolization, and 1 week after partial splenic artery embolization, there was no significant difference between the two groups. The measured values were as follows: hepatic arterial blood flow was 382.57 卤314.53 ml / min, splenic artery blood flow was 486.56 卤135.68 ml / min, splenic vein blood flow was 1026.62 卤43.59 ml / min, portal vein blood flow was 1376.45 卤44.17 ml / min, compared with pre-operation, hepatic arterial blood flow increased, and other indexes decreased (P 0.05). Conclusion: splenic artery in patients with hypersplenism due to portal hypertension in liver cirrhosis, the diameter of splenic vein and the volume of circulating blood are increased. Splenic embolization can reduce the volume of splenic circulation and decrease the pressure of portal vein. At the same time, it can increase hepatic arterial blood supply.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2;R445.1

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