丹参,黄芪对肝硬化门脉高压血流动力学的影响

目的：观察丹参、黄芪对肝硬化门脉高压血流动力学的影响。方法：６７例肝硬化门脉高压患者随机分为常规治疗组和丹参、黄芪治疗组,分别于治疗前及治疗１月、２月、３月监测门静脉内径、脾静脉内径、门静脉血流速度、脾静脉血流速度加快,门静脉血流量、脾静脉血流量减少,与常规治疗组比较有显著差异性。结论：丹参、黄芪能较好地改善肝硬化门脉高压。     

彩色多普勒对肝硬化门脉高压病人治疗前后门脉血流动力学的观察

目的:研究药物治疗前后门脉高压的血流动力学的改变.方法:用彩色多普勒超声诊断仪检测50例肝硬化门脉高压患者在治疗前后门脉血流动力学的变化.结果:用药后门静脉流速降低,脾静脉流速、流量降低,肝动脉的阻力指数和搏动指数降低.结论:肝动脉的阻力指数和搏动指数是判断门脉阻力的良好指标.     

抗肝纤方对早期肝硬化门脉高压症患者血流动力学的影响

目的：探讨抗肝纤方对早期肝硬化门脉高压症患者血流动力学的影响。方法2013年1月~2014年5月,将符合诊断标准的60例患者,按照随机数字表法分为治疗组和对照组各30例,治疗组采用抗纤方治疗,对照组使用盐酸普萘洛尔配合大黄蟅虫胶囊进行治疗。观察两组治疗前后的门静脉内径（DPV）、脾静脉内径（DSV）、脾静脉血流量（SVF）、门静脉血流量（PVF）及肝纤维化指标变化情况。结果治疗后,两组均能明显降低血清中HA、PCⅢ、LN、CⅣ值,但两组差异无统计学意义（P>0.05）;两组均能降低DPV、DSV、PVF值,且治疗组的SVF值明显降低（P<0.01）,治疗后,两组患者的DSV、PVF、SVF值比较,差异有统计学意义（P<0.05）。结论抗肝纤方能有效地缓解患者的肝纤维化病情,且可改善其血流动力学指标,值得在临床推广。     

双功多普勒对肝硬化门脉高压的血流动力学研究

既往应用双功多普勒（Dupl6XUltr8SOop－phy，DU）对肝硬化门脉高压的血流动力学所作的临床研究中，因受到各种主、客观因素的影响，结果各不相同［’·’。’：，且未见对肝硬化不同肝功能状态下的血流动力学变化的系统观察。本文尽量避免主、客观因素的影响，观察在代偿。失代偿两种肝功能状态下肝硬化门脉高压的血流动力学变化，以进一步探讨肝硬化门脉高压形成的病理生理过程。1对象与方法1．1对象：经临床诊断的肝硬化（LC）住院病人48例，男32例，女16例，年龄23－78岁，平均53岁。其中乙肝性32例，酒精性15例，胆汁性1例。病员分…     

复方丹参滴丸对肝硬化门脉血流的影响

目的：探讨复方丹参滴丸对肝硬化门脉血流的变化.方法：利用彩色多普勒超声,测定代偿期肝硬化组（27例）及失代偿期肝硬化组（13例）患者经复方丹参滴丸治疗前、后肝门脉内径（Dpv）、横截面积（Spv）、血流速度（Vpv）、充血指数（Ipv=Spv/Vpv）、血流量（Qpv）.结果：经复方丹参滴丸治疗后,代偿期肝硬化组及失代偿期肝硬化组Dpv、Spv、Ipv、Vpv、Qpv治疗前后差异均有显著性意义（P〈0.05或0.01）.结论：复方丹参滴丸对肝硬化门脉血流动力学有明显改善.     

肝硬化门脉高压与内皮素的关系探讨

目的探讨肝硬化门脉高压（Ｐｏｒｔａｌ ｈｙｐｅｒｔｅｎｓｉｏｎ，ＰＴＨ）的血流动力学变化及其与血中内皮素（ＥＴ）的关系。方法４８例肝硬化ＰＴＨ病人（代偿期１８例，失代偿期３０例）及３２例正常人作为研究对象，应用双功多普勒测定门、脾静脉血流量（ＰＶＢＦ＆ＳＶＢＦ），同步测定血中ＥＴ的水平，并分析ＰＶＢＦ＆ＳＶＢＦ的相关性。结果门脉系统高血流动力学改变存在于肝硬化ＰＴＨ发病的始终，ＥＴ的生成与门脉高血流动力学变化无相关性。     

生长抑素对肝硬化门脉高压病人血流的影响

目的：探讨生长抑素对肝硬化门脉高压病人血流的影响。方法：１１例肝硬化门脉高压病人，男性８例，女性３例，年龄４９±ｓ１２ａ，用生长抑素２５０μｇ／ｈ持续静脉滴注（静滴），１５ｍｉｎ后再用２５０μｇ，ｉｖ冲击治疗。分别用彩色多普勒超声技术检测用药前后门脉系统血流动力学。结果：持续静滴前后对比及冲击注射前后对比，门脉主干、脾静脉、肠系膜上静脉内径有所缩小，但Ｐ＞０．０５；而血流流速明显减慢，血流量明显减少（Ｐ＜０．０１或Ｐ＜０．０５）。结论：生长抑素可明显减少门脉系统血流量，降低门脉压力     

彩色多普勒超声测定肝硬化门脉血流的临床意义

目的探讨彩色多普勒超声检测肝硬化门静脉血流动力学改变的临床意义。方法采用彩色多普勒超声测量120例肝硬化患者门静脉、脾静脉内径、血流速度、血流量,其中64例进行电子胃镜检查,并对上述血流动力学指标与肝功能Child—Pugh分级、食管静脉曲张程度的关系进行分析。结果肝硬化Child-PtIsh分级越差,门静脉及脾静脉内径、血流量值越大,而血流速度则越慢（P〈0．05）。食管静脉曲张重度组门静脉及脾静脉内径、血流量均较轻中度组显著升高,而血流速度则较轻中度组显著下降（P〈0．05）。结论彩色多普勒超声测定肝硬化门脉血流对判断肝功能及食管静脉曲张程度有重要意义,有助于指导随访观察,为临床诊治提供帮助。     

超声对肝硬化患者肾脏血流动力学改变的分析

目的：探讨不同阶段肝硬化患者肾血流动力学的变化，评价彩色多普勒血流显像技术（CDFI）对该种患者肾早期病变的诊断价值。方法：应用CDFI监测30例肝硬化患者和20名健康对照者的各段肾动脉阻力指数（RI）。结果：肝硬化患者肾动脉砌由肾门至肾皮质依次降低的规律消失，肝硬化的肾主动脉、叶问动脉、小叶问动脉的RI比正常对照组有显著增高（P〈0．05），失代偿期大量腹水肾动脉砌的升高更显著，而血清肌酐．尿素氮水平与对照组相比差异无显著性。结论：应用CDFI监测肾动脉RI可为判断肝硬化患者早期肾功能损害提供较敏感的指标。从肾门到皮质动脉阻力梯度降低的趋势消失为研究肝肾综合征的发病机制提供了直观的血流动力学信息，对肝硬化腹水的治疗观察、肝肾综合征的预测有重要的参考价值。     

超声对肝硬化患者肾脏血流动力学改变的相关分析

目的探讨超声对肝硬化患者肾脏血流动力学改变的观测价值。方法选取肝硬化代偿期患者69例作为甲组、肝硬化失代偿期患者79例作为乙组,另选取健康人群140例作为对照组。应用超声技术检测3组不同病程时的肾脏血流动力学变化。比较3组收缩期峰值流速、舒张期末流速和阻力指数。结果甲组收缩期峰值流速、舒张期末流速和阻力指数与对照组比较差异无统计学意义(P>0.05);乙组收缩期峰值流速慢于对照组,舒张末期流速快于对照组,阻力指数高于对照组,差异均有统计学意义(P<0.05)。在肝硬化患者肝肾综合征期,超声显示肾血流量明显减少,皮质血流接近消失,叶间动脉变细,边缘可呈片状缺失,阻力指数显著升高。结论超声技术能较客观准确地根据肾动脉血流参数变化对肝硬化患者进行病情监测和诊断,值得临床推广应用。     

Effects of ondansetron on portal hemodynamics in liver cirrhosis

OBJECTIVE: The double-blind randomized pilot study was undertaken to compare the effects of a 10-day course of ondansetron 8 mg/day and propranolol 80 mg/day perorally in treating portal hypertension. SUBIECTS AND METHODS: 16 patients with liver disease were enrolled in the study. Measurements of portal vein diameter, portal blood flow velocity and portal blood flow volume were done at days 1, 5 and 10 of treatment using duplex Doppler sonography. RESULTS: The propranolol group demonstrated a decrease in portal venous diameter, while patients treated with ondansetron exhibited reduced portal blood flow velocity values. A decreased portal blood flow volume was found in both groups after 10 days of therapy. CONCLUSION: No statistically significant differences were found between the groups with the exception of portal venous diameter which is significantly lower at the end of the treatment in the case of propranolol.     

The effects of propranolol on hepatic encephalopathy in patients with cirrhosis and portal hypertension

Beta adrenoreceptor blocking drugs have been used for the prevention of haemorrhage from oesophageal varices. However, it is possible that these agents, by virtue of their effects on hepatic blood flow, may impair liver function and precipitate hepatic encephalopathy. We have therefore studied the effect of the beta blocking drug propranolol on hepatic encephalopathy in patients with cirrhosis and portal hypertension. Twenty patients were randomly assigned to receive 4 weeks treatment with propranolol or an identical-looking placebo, the former given in a dose sufficient to reduce resting pulse rate by greater than or equal to 25%. Before and after treatment patients were assessed for the severity of liver disease and the presence of encephalopathy. EEG mean cycle frequency and fasting arterial ammonia concentrations were also measured, and in order to detect latent hepatic encephalopathy, each patient underwent a battery of psychometric tests. Patients were blinded as to their treatment, as were those assessing their responses. Neither propranolol nor placebo had any significant effect on the parameters measured. On propranolol median EEG mean cycle frequency fell from 9.08 ct s-1 (range 8.63-11.0 ct s-1) to 8.73 ct s-1 (range 8.27-11.44 ct s-1), and median fasting arterial ammonia concentration fell from 66 mumol litre-1 (range 40-329 mumol litre-1) to 49 mumol litre-1 (range 37-188 mumol litre-1). Psychometric test values, while initially abnormal and suggestive of latent hepatic encephalopathy in the majority of patients, did not change significantly during the study.     

肝硬化门脉高压患者脾切除术后并发症的预防

目的探讨肝硬化门脉高压合并脾大、脾功能亢进患者行脾切除术后发生大出血等并发症的原因及预防措施。方法对本科2000年5月至2007年12月肝硬化门脉高压病脾切除术(包括同时行门奇断流术)者共计108例行术前、术中、术后全程严密监测处理。结果本科2000年5月至2007年12月肝硬化门脉高压病脾切除术(包括同时行门奇断流术)者共计108例,无1例出现术中或术后大出血导致严重并发症。结论术前术中及术后全程严密监测处理可减少和避免肝硬化门脉高压合并脾大、脾功能亢进患者行脾切除术后发生严重并发症。     

阿魏酸钠对溃疡性结肠炎患者血小板功能异常的影响

目的:探讨阿魏酸钠对溃疡性结肠炎(UC)患者血小板异常功能状态的影响。方法:采用ELISA法,单克隆酶联免疫吸附法及血小板粘附检测仪检测39例活动期及25例缓解期UC患者与30例健康对照者的血小板a颗粒膜蛋白(GMP-140)、血栓烷B2(TXB2)、6-酮-前列腺素F1a(6-Keto-PGF1a)、血小板粘附率及血管性假血友病因子相关抗原(vWF:Ag)水平。结果:患者组血小板活化指标及血管内皮损伤程度显著高于对照组(P<0.01),活动期UC患者又明显高于缓解期UC患者(P<0.05)。阿魏酸钠治疗组治疗前后血小板活化指标、血管内皮损伤指标及临床疗效差异有显著性(P<0.05),而一般治疗组治疗前后差异无显著性(P>0.05)。结论:阿魏酸钠能明显抑制UC患者体内血小板活化,减轻炎症反应,对UC有一定治疗价植。     

磁共振成像定量门静脉高压症血流动力学改变与门静脉压力相关性研究

目的采用电影相位对比磁共振成像（MRI）定量测量肝硬化门静脉血流,评价其与术中门静脉压力相关性。方法 34例肝硬化门静脉高压患者为肝硬化组,男21例,女13例;平均年龄48.6岁;采用电影相位对比MRI对34例门静脉高压症患者术前1周行门静脉血流定量测量,术中测量门静脉压力。对照组为性别比、年龄与肝硬化组匹配的健康志愿者19例。结果肝硬化组门静脉主干截面积与对照组比较均显示显著性增大（P〈0.05）,肝硬化组门静脉血流量为（21.71±12.42）cm3/s,与正常组比较明显增高（P〈0.05）,肝硬化组流速较正常对照组略减低,但差异无统计学意义（P〉0.05）。34例门静脉高压患者术中测压,门静脉压力明显增高,为（33.79±5.32）cm H2O柱,门静脉流量与压力行pearson相关性分析,无明显相关性（r=0.293,P〈0.01）。结论电影MRI肝硬化术前门静脉血流定量可客观显示门静脉系统呈高血流动力学改变,门静脉压力亦可以反映肝硬化严重程度,但门静脉血流量与压力无明显相关性。     

Pharmacodynamic and pharmacokinetic study of propranolol in patients with cirrhosis and portal hypertension.

1. The aim of this study was to investigate the pharmacokinetics and the beta-adrenoceptor blocking activity according to time of conventional (C) and long acting (LA) propranolol in cirrhotic patients. Twenty-four patients with alcoholic cirrhosis and oesophageal varices were randomly assigned to receive either 160 mg C propranolol, 160 mg LA propranolol or placebo acutely and then following repeated administration (acute and chronic phases). Thereafter propranolol concentrations and beta-adrenoceptor blockade (resting and exercise heart rates) were measured at different intervals. 2. The Cmax was significantly higher with C propranolol in both phases. The time of Cmax was significantly later with LA propranolol in both phases. The AUCs were significantly higher after chronic administration with both formulations of propranolol. 3. The exercise peaks of beta-adrenoceptor blockade were similar between the two formulations and between the two phases of administration of propranolol. The duration of effective beta-adrenoceptor blockade was significantly longer in the chronic phase and seemed to be longer with LA than with C propranolol although this was not significant (72 +/- 31 vs 48 +/- 18 h, respectively). 4. There was a significant correlation between the log propranolol concentration and exercise heart rate but not with resting heart rate. No correlation could be demonstrated between pharmacological data and the Child Pugh score. 5. We conclude that in cirrhotic patients exercise testing was a reliable method in the assessment of beta-adrenoceptor blockade. Pharmacology of propranolol was found to be different according to the formulation or to the phase of administration.     

TIPSS加断流术治疗肝硬化门脉高压并消化道出血

20世纪 70年代 ,Lunderquist等[1] 采用经皮经肝穿刺门静脉栓塞曲张的食管胃底静脉 ,治疗门静脉高压引起的消化道出血 ,临床止血成功率达 70 %～ 90 % ,由于此项治疗不能降低门静脉压力 ,致使术后半年再出血率 38%～ 70 % ,2年再出血率 71 %～ 90 %。 2 0世纪90年代初开展的经颈静脉肝内门体静脉分流术 (transi jugularintrahepaticportal systemicshunt,TIPSS) ,治疗急重症门脉高压出血获得了有效的降压止血作用[2 ] 。我们在此基础上同时行曲张的胃冠状静脉及胃短静脉栓塞 ,达到了集分流术和断流术为一体的双重治疗效果 ,现报告如下 ,…     

TIPSS加断流术治疗肝硬化门脉高压并消化道出血

20世纪70年代,Lunderquist等[1]采用经皮经肝穿刺门静脉栓塞曲张的食管胃底静脉,治疗门静脉高压引起的消化道出血,临床止血成功率达70%～90%,由于此项治疗不能降低门静脉压力,致使术后半年再出血率38%～70%,2年再出血率71%～90%.