甲氰咪胍对肝硬化门脉高压症犬门脉血液动力学的影响

目的：探讨甲氰咪胍对肝硬化门脉高压症犬门脉血液动力学的影响。 方法：以胆总管结扎法成功制备胆汁性肝硬化门脉高压症模型犬11只,随机分为两组,即甲氰咪胍组（n=7）和盐水对照组（n=4）;另取4只正常犬作正常对照组。经股动脉、股静脉、右颈外静脉分别插管,以多导生理记录仪、电磁流量计等检测门脉及全身血液动力学变化,使用RF-3000型荧光分光光度计测量血浆组织胺浓度。 结果：甲氰咪胍组静脉注射甲氰咪胍（剂量0.012 g•kg^-1）5、15、30、60、90和120 min后,自由门脉压平均值分别较注射前下降5.2%、14.1%、13.7%、12.9%、9.3%和6.5%（P<0.05,P<0.01,P<0.01,P<0.01,P<0.01,P<0.05）,肝静脉楔入压、肝静脉压梯度、门静脉阻力均同步下降。肝动脉血流量无显著改变,门静脉血流量及全肝血流量轻度增多。肝静脉自由压、下腔静脉压、腹主动脉平均压及心率均无明显变化。自由门静脉压下降最大幅度与股静脉血血浆组织胺浓度呈显著正相关（r=0.787 4,P<0.05）。盐水对照组及正常对照组上述各指标均无显著变化。 结论：甲氰咪胍通过拮抗肝硬化门脉高压症犬血中异常升高的组织胺的作用,舒张肝血管床,降低门脉血流阻力,从而降低门脉压力,同时使门脉及全肝血流量轻度增加,而对全身血流动力学无不良影响。     

乙肝后肝硬化脾功能亢进患者部分性脾脏栓塞术后血流动力变化初步研究

目的观察肝硬化门静脉高压伴脾功能亢进患者部分性脾脏栓塞术（PSE）在术前、术后肝动脉、脾动脉及门静脉血流动力学变化,探讨PSE对门静脉高压治疗的效果。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分别于PSE术前及术后检测肝动脉、脾动脉、脾静脉及门静脉血管内径,平均血流速度、血流量和动脉血管阻力。用统计学方法分析术前、术后各项观察指标的变化。结果 PSE术后肝动脉血流速度、血流量较术前增加,脾动脉、脾静脉及门静脉血管内径及血流速度及血流量较术前减少,P〈0.05,差异有统计学意义。结论 PSE术后肝动脉血流量增加,脾动脉、脾静脉血流量减少,可缓解脾循环高动力状态,间接降低门静脉压力。     

高剂量异丙酚对家兔肝血流阻力及肝血流量的影响

目的观察高剂量异丙酚对家兔肝血流阻力及肝血流量的影响,为临床合理用药提供依据。方法20只成年雄性健康家兔随机分为异丙酚组11例,输注异丙酚1.2mg/(kg·min)和对照组9例,输注等容量5%葡萄糖液,开腹游离门静脉和肝动脉,行颈总动脉、门静脉、肝静脉插管。循环稳定后给药,生理记录仪连续监测给药后90min内平均动脉压、门静脉压、肝静脉压,电磁血流仪连续测定门静脉和肝动脉血流量,计算门静脉、肝静脉血管阻力。结果给药30min后各时点,异丙酚组平均动脉压较对照组明显下降(P<0.05),但肝血流量较对照组明显增加(P<0.05),以门静脉血流量增加为主,同期门静脉、肝静脉血管阻力明显低于对照组(P<0.05)。结论高剂量异丙酚虽降低肝灌注压,但同时也使肝血管阻力显著降低,明显提高肝脏血液灌注。     

异搏定对肝硬变门脉高压症狗肝脏血液动力学的影响

实验观察了异搏定对肝硬变门脉高压症狗肝脏和全身血液动力学的影响。结果表明：异搏定显著降低腹主动脉压和肝动脉血流阻力，而对门脉压、门脉血流量及门脉血流阻力均无明显影响。说明异搏定对肝硬变门脉高压症肝脏血液动力学影响较小，而对全身血液动力学有明显作用。提示异搏定对肝硬变狗肝脏血液动力学无任何有益作用，结果不支持异搏定用于肝硬变门脉高压症的治疗。     

异搏定对肝硬变门脉高压症狗肝脏血液动力学的影响

实验观察了异搏定对肝硬变门脉高压症狗肝脏和全身血液动力学的影响。结果表明：异搏定显著降低腹主动脉压和肝动脉血流阻力，而对门脉压、门脉血流量及门脉血流阻力均无显著影响。说明异搏定对肝硬变门脉高压症肝脏血流动力学影响较小，而对全身血液动力学有明显作用。提示异搏定对肝硬变肝脏血流动力学无任何有益作用，结果不支持异搏定用于肝硬变门脉高压症的治疗。     

门静脉内注射葡聚糖微球建立门静脉高压症犬的血流动力学研究

目的 门静脉内反复注入葡聚糖微球建立犬门静脉高压症动物模型,结合ALC-BFS血流测定系统观察门静脉高压症犬血流动力学改变,并研究其发生机制.方法 16只犬建立门静脉插管后随机分成对照组(n=6)和实验组(n=10),实验组经导管向门静脉内注射葡聚糖微球,每5天1次,共6次,对照组同样方法注射生理盐水.实验过程中观察门静脉压力、血常规、肝功能、脾脏大小、肝脏病理变化;并行门静脉系统造影了解侧支循环的形成情况;应用ALC-BFS血流测定系统观察门静脉、脾静脉、肝动脉、脾动脉的血流动力学指标的变化.结果 实验组动物经门静脉注射葡聚糖微球后门静脉压力立即升高,术后4个月门静脉压力仍维持在(23.35±2.63)cmH2O,血常规、肝功能基本正常,组织学检查显示肝脏汇管区纤维化明显;门静脉系统造影可见门静脉末梢血管栓塞,侧支循环形成.与术前及对照组相比,术后4个月实验组犬的门静脉、脾静脉、肝动脉、脾动脉血管管径增宽;门静脉血流速度减慢,血流量轻微改变;脾静脉血流速度减慢,血流量增加;肝动脉、脾动脉血流速度增快,血流量增加.结论 经门静脉内注射葡聚糖微球栓塞门静脉末梢可以建立稳定的犬门静脉高压症模型;门静脉系统血流动力学测定显示血流速度减慢,肝动脉、脾动脉血流增加.     

狗总胆管结扎所致肝硬化门脉高压症的肝脏血流动力学改变

本实验通过自身对照研究探讨狗总胆管结扎(CBDL)所致肝硬化门脉高压症的肝脏血流动力学的特征,结果表明:狗总胆管结扎后门静脉压力、嵌塞肝静脉压力、门-腔静脉压力梯度均较结扎前明显增加,门静脉血流量明显减少,而肝动脉血流量明显增加。门静脉血管阻力明显增加,而肝动脉血管阻力明显降低。肝脏组织学检查显示为完全和(或)不完全分隔型纤维间隔形成。上述改变与人类肝硬化门脉高压所见者一致。     

甲氰咪胍对肝硬变门静脉高压症患者门静脉压力影响的初步观察

肝硬变时血中组织胺等液递物质含量增加,并促使门静脉压力(PVP)升高。本文观察了组织胺受体拮抗剂甲氰咪胍对肝硬变门静脉高压症患者PVP的影响,发现经周围静脉一次快速推注甲氨咪胍0.2g使肝硬变门静脉高压症患者的PVP平均下降0.42kpa,其中4例下降幅度达0.49～0.69kpa。PVP的下降幅度与血清白蛋白浓度呈高度负相关(r=-0.76;P<0.05)。肝组织学检查发现,PVP下降幅度较大的患者其肝细胞变性坏死也较严重。对照组(非肝硬变患者)给予甲氰咪胍后PVP无明显变化。本文结果说明通过拮抗肝硬变时血中某些异常升高的液递物质,可以达到降低PVP的目的。     

背驮式肝移植术门脉高压症患者血液动力学分析

目的观察分析背驮式肝移植术门脉高压症患者血液动力学改变.方法 20例门脉高压症终末期患者在静-吸复合全身麻醉下行背驮式肝移植术.并记录手术开始后30 min、无肝期5 min、无肝期30 min及新肝期3 min、新肝期10 min、新肝期30 min的中心静脉压（CVP）、肺动脉平均压（MPAP）、肺动脉楔压（PAWP）、心脏指数（CI）、体循环阻力指数（SVRI）、肺循环阻力指数（PVRI）血液动力学指标.结果无肝期MPAP、PCWP、CVP均低于手术开始后30 min（P〈0.05）,但SVI、CI减少不明显,无肝期血液动力学基本平稳;在新肝开放后血液动力学指标的变化明显,MPAP、PCWP、CVP升高（P〈0.01）,CI降低,肺动脉平均压（MPAP）和肺循环阻力指数（PVRI）增高（P〈0.05）.结论背驮式肝移植术门脉高压症患者血液动力学指标的变化明显,应加强此术式血液动力学的监测和管理,特别是在新肝开放后,血液动力学指标的变化更明显.     

门静脉血栓形成的危险因素、监测与治疗

<正>门静脉的结构、功能:肝脏的血流主要来源于肝动脉以及门静脉,其中门静脉提供了75%的血流量,肝动脉提供了25%的血流量。门静脉由脾静脉及肠系膜上静脉汇合而成,进入肝脏后,在肝脏内反复分支汇入肝血窦(也称为肝窦),血液充分与肝细胞接触并进行物质交换后,经末端毛细血管汇入左、右肝静脉内,最终合并为一条肝静脉回流至下腔静脉。来自肠系膜及脾脏的血液经过门静脉进入到肝脏中,     

The effects of the combination of phentolamine and vasopressin on hepatic and systemic hemodynamics in girrhotic portal hypertensive dog model

Summary The experimental study was aimed at elucidating the effects of phentolamine and vasopressin used separately or in combination on hepatic and systemic hemodynamics in cirrhotic portal hypertensive dogs. The results showed that either of the two drugs used separately could lead to reduction in portal venous pressure and could also influence systemic hemodynamics or lower hepatic blood flow. When phentolamine in combination with vasopressin was administered, no side-effect could be found on hepatic and systemic hemodynamics, suggesting that the drugs used in combination could efficaciously decrease portal hypertension and counteract their respective side-effect. This combination therapy will be useful in treating bleeding from esophageal variceal rupture in cirrhotic patients with portal hypertension.     

联用小剂量心得安与川芎嗪对肝硬化犬血流动力学的影响

目的;探讨小剂量心得安与川芎嗪联用对肝硬化门脉高压犬血流动力学的影响及其作用机理。方法：在用药前后采用血管法检测９只肝硬化门脉高血犬血流动力学的变化,并检测其肝,肾功能。结果：小剂量心得安与川芎嗪联用３０分钟后,可使肝硬化犬肝脉嵌塞压（ＷＨＶＰ）,肝静脉压力梯度（ＨＶＰＧ）及门静脉压（Ｐｐｖ）显著降低（Ｐ〈０．０５－０．０１）,于６０分钟达最低点,但对平均动脉压（ＭＡＰ）、心率（ＨＲ）无明显影响,     

Effect of phentolamine in combination with pituitrin on the hepatic and systemic hemodynamics]

This experimental study was aimed at the effect of phentolamine used separately or in combination with pituitrin on hepatic and systemic hemodynamics in cirrhotic portal hypertensive dogs. The results showed that either of these drugs used separately could lead to reduction of portal venous pressure. Each of the drugs could also cause by-effect on systemic hemodynamics, or reduce hepatic blood flow. When phentolamine was used in combination with pituitrin no side effect was found in hepatic and systemic hemodynamics. It was suggested that phentolamine used in combination with pituitrin could efficiently decrease portal hypertension and counteract the side-effects. It would be useful in treatment of bleeding from esophageal variceal rupture in cirrhotic patients with portal hypertension.     

An animal study of portal hypertension

For the purpose of elucidation the mechanism of portal venous resistance and portal venous blood flow in maintaining an elevated portal hypertension. The splanchnic and systemic hemodynamics were evaluated in portal hypertensive rat model, which is induced by partial portal vein ligation (PVL). Organ blood flow and portal-systemic shunting were measured by radio-active microsphere techniques. In this study all the PVL rats had higher mean portal venous pressure (15.2 +/- 1.6 mmHg) when compared to the Sham-operation control rats (5.3 +/- 1.2 mmHg). Furthermore, portal systemic shunting was significantly higher in the 14th day PVL rats (87.2 +/- 3.6%) than control rats (0.3 +/- 0.1%) (p less than 0.05). There was a rapid increase in portal venous inflow from the 4th day (6.1 +/- 0.8 vs 4.2 +/- 0.7 ml/min/100 gm BW, p less than 0.05) in the PVL rats than in control rats. However, the total peripheral resistance and splanchnic arterial resistance were reduced in the 14th PVL rats than control rats. The Cardiac index was much higher in the 14th PVL rats than control rats. Thus our results demonstrate that portal hypertension is maintained by a hyperdynamic portal venous inflow. This model is reproducible for us to study portal hypertension within a short period of time.     

An Experimental Study on the Disorders of Hepatic Hemodynamics and Changes of Plasma Histamine in Dogs with Fulminant Hepatic Failure

Alotofresearchprojectshavebeenconductedabouttherelationshipbetweenthehepatichemodynamicsandplasmavascularactivitysubstancesincirrhosiswithportalhypertension["ZJ.Buttherearefewarticlesaboutthechangesofhepatichemodynamicsandplasmahistamineinacutefulminanthepaticfailure.Themodeloffulminanthepaticfailureinducedbyacetaminophenwasestablishedindogstoobservethechangesofhepatichemodynamicsandplasmahistaminelevelsinportalvein,hepaticvein,abdominalaortaandinferiorvenacava.1MATERIALSANDMETHODS1'1E…     

硬膜外阻滞与安氟醚复合麻醉对血流动力学和肝血流及氧代谢的影响

目的：探讨硬膜外阻滞与安氟醚吸入复合麻醉对血流动力学和肝血流及氧代谢的影响。方法：选用健康杂种犬１０只行胸段硬膜外阻滞后吸入０．５和１．０ＭＡＣ（肺泡最低有效浓度，ｍｉｎｉｍｕｍａｌｖｅｏｌａｒｃｏｎｃｅｎｔｒａｔｉｏｎ）安氟醚，监测体循环、肺循环、肝动脉、门静脉血流动力学、全身及肝脏氧供、氧耗，肝血流用电磁血流仪测定。结果：硬膜外阻滞后血压、外周血管阻力、门静脉血流和氧供下降，加吸０．５ＭＡＣ安氟醚使心率、心排血量和全身氧供也下降；１．０ＭＡＣ后除血压、心排血量、外周血管阻力和全身氧供、门静脉血流及氧供进一步显著下降外，肝动脉血流及氧供也减少。结论：硬膜外阻滞后，随安氟醚浓度升高，体循环、肺循环、肝动脉、门静脉血流动力学、全身及肝脏氧供需平衡显著变化。