控制性低中心静脉压在肝硬化静脉曲张出血中的应用价值

目的:观察肝硬化食管静脉破裂出血患者中心静脉压(CVP)与门静脉血流变化之间的关系,探讨控制性低CVP在治疗中的应用价值。方法:59例肝硬化食管静脉破裂出血患者治疗过程中动态监测CVP,彩色多普勒超声仪检测门静脉内径、血流动力学的变化,并监测肝肾功能及血乳酸情况,比较不同中心静脉状态下门静脉内径、血流速度的变化,肝肾功能、血乳酸变化以及再出血发生率。结果:CVP与门静脉内径在一定范围内变化呈正相关,控制性低CVP组(CVP 4~6cmH₂O)、非控制性CVPⅠ组(CVP>6~12cmH₂O)、非控制CVPⅡ组(CVP>12cmH₂O)24h内再出血率分别为25.0%、64.7%、63.6%,控制性低CVP组与非控制性Ⅰ、Ⅱ组再出血率差异有统计学意义(P<0.05),非控制组内两组之间再出血率差异无统计学意义(P>0.05);3组之间肝、肾功能及乳酸变化均无统计学意义(P>0.05)。结论:肝硬化食管静脉破裂出血时CVP变化在一定范围内可间接反应门静脉血流变化,采用控制性低4~6cmH₂O可减少再出血发生率及器官功能障碍的发生。

Value of controlling low central venous pressure in variceal bleeding due to cirrhosis of liver

Objective：To explore the relation between central venous pressure （CVP） and portal venous flow in hepatocirrhosis variceal bleeding,and to study the clinical significance of controlling low central venous pressure. Methods：Fifty-nine patients who had suffered from hepatocirrhosis variceal bleeding and survived were analyzed retrospectively. CVP was dynamically monitored during the treatment. The inner diameter of vena portalis hepatis and the change of the hemodynamics of portal system were detected by color ultrasonagraphy ;the liver, renal function and blood lactic acid were monitored. The changes of the inner diameter of vena portalis hepatis, the changes of blood flow rate, the damage of the liver, renal function and the percentage of secondary bleeding were compared. Results： CVP had positive correlation with the inner diameter of vena portalis hepatic. The rate of secondary bleeding was 25.0% in the group controlling low CVP（4 -6 cmH2O） and 64.7% in group Ⅰ without controlling low CVP（ 〉6 - 12 cmH2O） and 63.6% in the groupⅡ without controlling low CVP（ 〉 12 cmH2 O）within 24 hours. The difference was distinct （P 〈 0.05 ） between the group with controlling CVP and the two groups without controlling CVP. The damage of liver, renal function and lactic acid were not significantly different among the three groups （ P 〉 0.05 ）. Conclusions ： The changes of central venous pressure during hepatocirrhosis vaficeal bleeding may indirectly display the hemodynamics of portal system. Dynamical monitoring of CVP and controlling low CVP within 4 - 6 cmH20 may decrease the incidence rates of secondary bleeding and dysfunction of organs.