三尖瓣返时门静脉血流动力学的呼吸性变化

目的 在正常呼吸情况下对正常人及不同程度的三尖瓣返流患者的门静脉血流频谱旨在探索影响门静脉血流稳定性的因素。方法 我们观察１９例正常人及２５例不同程度的三尖瓣返流患者的门静脉血流频谱。在正常呼吸的情况下观察门脉血流频谱的波动性,并计算血流波动系数以及波动系数流量三尖瓣返流者门静脉血流的呼吸性变化较正常人显著,且随返流程度的增加耐直至出现逆向血流。结论 正常人门静脉血流的波动生与腹压的呼吸性变化以及     

三尖瓣关闭不全对上腔静脉血流速度频谱的影响

目的探讨不同程度三尖瓣关闭不全对上腔静脉血流速度频谱的影响。方法随机选取三尖瓣关闭不全病例60例及健康对照20例,在胸骨旁四腔或心尖四腔切面测量三尖瓣返流面积与右心房面积之比确定返流程度。经右侧锁骨上窝探查上腔静脉血流速度频谱,记录3个呼吸周期的频谱曲线,观察其形态,计算各参数的呼吸变化率。结果三尖瓣轻度及中度关闭不全时,上腔静脉血流频谱参数的呼吸变化率与对照组无显著差异（P〉0．05）,且上腔静脉频谱形态无明显变化（P〉0．05）;三尖瓣重度关闭不全时,上腔静脉频谱参数S、D波的呼吸变化率较对照组明显减低,而VR、AR波增高（P〈0．05）,部分患者频谱形态发生变化。结论上腔静脉频谱参数的呼吸变化率随三尖瓣返流程度加重而改变,重度三尖瓣返流会引起上腔静脉频谱形态变化。     

彩色多普勒超声对缩窄性心包炎和限制型心肌病的鉴别诊断

目的　评价彩色多普勒超声对缩窄性心包炎 (CP)与限制型心肌病 (RCM )的鉴别诊断价值。方法　应用彩色多普勒超声观察CP、RCM二尖瓣口、三尖瓣口、肺静脉及肝静脉血流状况 ,并用脉冲多普勒取样 ,记录其频谱随呼吸而发生的速率和时间变化 ,并与正常组进行对照。结果　在呼气与吸气时 ,CP组二尖瓣、三尖瓣舒张期速率峰值 (EM,ET)与正常组比较差异有显著性意义 (P <0 .0 5 ) ,且EM 随呼吸变化平均 >3 0 % ,而RCM和正常组平均 <5 % ;收缩期CP组二尖瓣、三尖瓣反流发生率明显低于RCM组 ,且程度较轻 ;CP组吸气与呼气时 ,分别发生肺静脉收缩期血流速率 (S)或舒张期血流速率 (D)值增大 ,而RCM组变化不明显 ;CP和RCM组肝静脉频谱D值和S值随呼吸呈不同的变化 ,而正常组受呼吸变化影响较小。结论　彩色多普勒血流显像技术为CP和RCM的鉴别提供了客观依据。如综合多项多普勒频谱征象并加以全面比较、分析 ,则具有相当的诊断和鉴别诊断价值及较高的敏感性和特异性     

多普勒超声检测主动脉瓣返流患者颈动脉血流变化

本文旨在观测主动脉瓣返流患者颈动脉血流动力学变化。观察组42例，其中主动脉瓣返流30例，主动脉瓣返流伴二尖瓣病变12例；正常组42例。正常顿总动脉频谱形态呈三峰形，舒张早期可有反向频谱，Vr10．8±3．6cm／s，△T／T比值＜1／10。主动脉瓣返流患者颈动脉收缩期V1、AC、DC均显著增大；舒张期可出现“返流频谱”，即△T／T比值≥1／10。根据△T／T比值可大致分级主动脉瓣返流程度，轻度返流：△T／T比值＜1／4或正常；中度；△T／T比值1／4～1／2；重度：△T／T比值＞1／2；可作为分级主动脉瓣返流程度的一种简便辅助方法。对于临床听不到杂音的主动脉瓣返流患者，颈动脉“返流频谱”可作为有用线索，提示病变存在。本文还探讨了收缩期颈动脉血流动力学变化。     

胎儿三尖瓣反流与脐动脉及大脑中动脉超声血流频谱的相关性分析

目的观察胎儿三尖瓣反流时脐动脉和大脑中动脉(MCA)血流频谱的变化,探讨不同程度胎儿三尖瓣反流对脐动脉和MCA血流频谱的影响。方法测量三尖瓣反流时胎儿脐动脉和MCA的血流频谱,分析胎儿不同程度三尖瓣反流时脐动脉和MCA频谱的变化情况,并与对照组比较分析。结果三尖瓣Ⅰ、Ⅱ级反流时,胎儿脐动脉和MCA血流频谱与对照组比较差异无统计学意义。三尖瓣Ⅲ、Ⅳ级反流时,脐动脉阻力指数、搏动指数及收缩期峰值血流速度与舒张期血流速度比值(S/D)均增高,MCA阻力指数、搏动指数及S/D均降低,与对照组比较差异有统计学意义(P﹤0.05)。结论三尖瓣Ⅰ、Ⅱ级反流对胎盘功能影响不大,宫内缺氧不明显;中重度三尖瓣关闭不全则会影响胎盘功能,进而引起胎儿宫内缺氧,产生脑保护效应。     

胎儿三尖瓣反流与脐动脉及大脑中动脉超声血流频谱的相关性分析

目的观察胎儿三尖瓣反流时脐动脉和大脑中动脉（MCA）血流频谱的变化,探讨不同程度胎儿三尖瓣反流对脐动脉和MCA血流频谱的影响。方法测量三尖瓣反流时胎儿脐动脉和MCA的血流频谱,分析胎儿不同程度三尖瓣反流时脐动脉和MCA频谱的变化情况,并与对照组比较分析。结果三尖瓣I、Ⅱ级反流时,胎儿脐动脉和MCA血流频谱与对照组比较差异无统计学意义。三尖瓣Ⅲ、Ⅳ级反流时,脐动脉阻力指数、搏动指数及收缩期峰值血流速度与舒张期血流速度比值（s／D）均增高,MCA阻力指数、搏动指数及s／D均降低,与对照组比较差异有统计学意义（P〈0．05）。结论三尖瓣I、Ⅱ级反流对胎盘功能影响不大,宫内缺氧不明显;中重度三尖瓣关闭不全则会影响胎盘功能,进而引起胎儿官内缺氧,产生脑保护效应。     

彩超对肝脏弥漫性病变肝静脉门静脉血流检测意义

目的：本通过对肝脏弥漫性病变患门静脉，肝静脉的超声多普勒频谱分析。以确定二之间的相关性，将其作为肝弥漫性病变的定量性检测指标，并对比分析肝脏血流多普勒检查对肝脏弥漫性损害程度的诊断意义。方法：运用彩色多普勒超声对116例肝弥漫性病变与33例正常人肝静脉和门静脉血流频谱的检测以分析其相关性。结果：正常人肝静脉呈双向三峰型，门静脉流速＜0．15cm/s，正向平直血流，急性肝炎组肝静脉与门静脉多普勒频谱与正常人无显性差异，脂肪肝，慢性肝炎与肝硬化组肝静脉血流波形分为三种双向三峰型，平直型，单向双峰或单向波峰减低型，门静脉频谱可分为正向流速正常，正向流速减慢，双向流速减慢，离肝负向减慢血流，肝静脉，门静脉频谱的变化与肝弥漫性病变分类间存在着明显的差异，结论：对肝静脉门静脉超声多普勒血流检测可以作为肝弥漫性为诊断的一项定量性检测手段。     

左室永久性起搏的彩色多普勒血流显像观察

本文应用彩色多普勒血流显像检测了安置VVI起搏器33例患者及正常人21例。在起搏组33例患者中，发现三尖瓣返流12例，发生率为36．4％；心包积液2例，占6％；感染性心内膜炎及电极脱位各1例。年龄匹配正常组，无1例返流。本文还重点讨论了右室起搏发生三尖瓣返流的机理，主要与起搏电极跨越三尖瓣的位置密切有关。同时提出了明显的三尖瓣返流可能参与或促发起搏器综合征的形成。     

非乙醇性脂肪肝病人肝、门静脉及血流频谱超声检测

目的 探讨非乙醇性脂肪肝病人门静脉、肝静脉管径及血流频谱的变化特点。方法 运用彩色多普勒超声检测159例轻、中、重度非乙醇性脂肪肝病人门静脉、肝静脉管径及血流频谱,与40例正常肝组织作对比分析。结果 轻度脂肪肝各项检查指标与正常组比较无明显差异,随脂肪肝程度加重,肝静脉管径逐渐变小、异常波形增多,门静脉管径逐渐增大、血流速度减慢;轻、中、重度脂肪肝肝静脉管径与异常血流频谱（平坦波和衰减波）、门静脉管径与门静脉血流速度各组间比较差异有显著性（t=2.66～3.85;χ^2=10.77、5.53,P〈0.05）。结论 非乙醇性脂肪肝肝静脉、门静脉管径及血流频谱的变化有其自身特点,且与病情的严重程度相关,多普勒血流频谱变化可能成为病情严重程度评估的客观指标之一。     

以立体角代替平面角彩色多普勒血流会聚法评估三尖瓣返流程度

目的　探讨彩色多普勒血流会聚法在评估三尖瓣返流程度中的应用价值。方法　应用不同的血流会聚方程对３２例三尖瓣返流患者的返流程度进行测量, 并与传统法所测指标进行比较。结果　应用立体角会聚方程计算的返流率（Ｆ２）与传统方法测得的返流束指标ＳＲ／ＳＲＡ、ＶＰ 以及二维多普勒方法计算的每搏返流量Ｑ之间的相关关系（ｒ分别为０．４８, ０．４６, ０．９８）优于应用平面角会聚方程计算的返流率（Ｆ１）, 与上述指标之间的相关关系（ｒ分别为０．４６, ０．４４, ０．９２）。而且ＳＶ１明显低估返流程度,ＳＶ２更接近于实际值。结论　应用立体角会聚方程代替平面角会聚方程能更为准确地评估三尖瓣返流程度     

Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow

PURPOSE: The role of respiration in modulating blood flow in the portal vein is unclear. The aim of this study was to investigate the phenomenon of respiration-dependent periodic hepatofugal portal venous blood flow as detected on color Doppler sonography. METHODS: Within 1 year, we identified 13 patients with respiration-dependent reversal of blood flow in the portal vein that was diagnosed on color Doppler sonography. This phenomenon was investigated by color Doppler sonographic examination of the portal venous flow during both mid-inspiration breath-holding and a respiratory cycle including deep inspiration; evaluation of hepatic vein Doppler waveforms as normal (triphasic) or decreased (flattened); and echocardiographic examination to determine the presence or absence of tricuspid regurgitation. RESULTS: The patients' median age was 53 years (range, 26-87 years). Seven of the 13 patients had heart disease (tricuspid regurgitation) with or without liver disease, 3 had liver disease without heart disease, and 3 had other diseases with no evidence of heart or liver disease. On Doppler sonography, 10 of the 13 patients had increased portal venous pulsatility (7 of the 10 had tricuspid regurgitation; the other 3 did not); the remaining 3 patients had neither increased pulsatility nor tricuspid regurgitation. Sonographic follow-up within 4 weeks in 4 of the 13 patients revealed loss of the respiration-dependent hepatofugal portal flow. CONCLUSIONS: Respiration-dependent hepatofugal portal flow is a rare finding associated with periodic portal hypertension in patients with right heart insufficiency and liver disease. Its clinical significance is unclear. Among our patients, its occurrence was predominantly associated with an increased venous pulsatility index due to tricuspid regurgitation or venous outflow obstruction. Further study is needed to investigate whether periodic respiration-dependent hepatofugal portal flow is predictive of the occurrence of continuous flow reversal.     

Portal Vein Pulsatility Ratio Provides a Measure of Right Heart Function in Chronic Heart Failure

Portal vein flow was recorded by color Doppler sonography in 31 patients with chronic heart failure and 18 control subjects. Compared with patients showing a forward flow (Group A), those with reversed portal vein flow (Group B) had higher prevalence of tricuspid regurgitation (75% vs. 43%), hepatic congestion (100% vs. 30%) and ascites (50% vs. 18%), and showed higher right atrial pressure (25.3 ± 3.01 mmHg vs. 11.8 ± 5.75 mmHg, p < 0.01). In controls, portal vein pulsatility ratio was 0.66 ± 0.08, in Group A it was 0.46 ± 0.28 (p < 0.01), in Group B −0.60 ± 0.19 (p < 0.01). Portal vein pulsatility ratio negatively correlated with right atrial pressure (r = −0.87; p < 0.01). In Group A, hepatic congestion, ascites and tricuspid regurgitation were associated with a higher portal vein pulsatility. This study indicates that portal vein pulsatility ratio reflects the level of impairment of the right heart.     

超声评价正常小儿肝脏血管的内径及血流动力学

目的 通过超声检查获取正常小儿肝脏血管的内径及血流动力学参数测值.方法 对213名正常小儿进行二维及多普勒超声检查,测量肝动脉的内径及阻力指数(RI)、搏动指数(PI),门静脉主干及分支的内径、血流速度、血流量.测量数据进行相邻年龄组间比较.结果 肝动脉的内径随着年龄的增长而增加且相邻组间差异有统计学意义,R1和PI则是相对较恒定的参数.门静脉主干及分支的内径及血流量随着年龄的增长而递增,但增幅减小,幼儿期增长最明显.门静脉主干及分支的血流速呈现随年龄增长增高后有回落的趋势.结论 小儿肝脏血管的内径及血流动力学随其生长发育也在不断变化,其增长的特点与小儿生长发育特点相吻合.     

Ultrasonography in the diagnosis of complications in patients with portal hypertension

This review focuses on ultrasonography (US) to diagnose patients with complications in portal hypertension. Clinicians first use US to evaluate patients with suspected portal hypertension, because US is quick, simple, and radiation free. US is necessary for grading and performing paracentesis for ascites. Doppler US-based detection of reverse splanchnic vein flow or the presence of a spontaneous portosystemic shunt is highly specific in patients with cirrhosis. Since it is important to estimate spleen size in patients with portal hypertension, spleen size is usually measured by US. Spleen volume can be more accurately measured with 3D-US. Estimation of viable residual splenic volume after partial splenic embolization should be limited to cases with total splenic volume less than 1000 ml. Portal vein thrombosis is often detected during the US examination performed when symptoms first appear or during the follow-up. Two-dimensional transthoracic echocardiography is an excellent noninvasive screening test in patients with pulmonary portal hypertension who can undergo it. By measuring the maximum and minimum diastolic blood flow velocities in the renal arteries using renal color Doppler US, the pulsatility index (PI) and resistive index (RI) can be calculated. The PI and RI in cirrhotic patients were significantly higher than those in healthy subjects and patients with chronic hepatitis, and showed a significant positive correlation with the Child–Pugh Score. In conclusion, US is an essential tool for the diagnosis and treatment of patients with portal hypertension.

     

Effects of diffuse fatty infiltration of the liver on portal vein flow hemodynamics

PURPOSE: To investigate the effects of various degrees of diffuse fatty infiltration of the liver on portal vein blood flow with Doppler sonography. METHODS: One hundred forty subjects were examined with color and spectral Doppler sonography. The subjects were divided into 4 groups of 35 subjects each according to the degree (normal, grade 1, grade 2 and grade 3) of hepatic fatty infiltration assessed on gray-scale images. The portal vein pulsatility index (VPI) and time-averaged mean flow velocity (MFV) were calculated for each subject. VPI was calculated as (peak maximum velocity - peak minimum velocity) / peak maximum velocity. RESULTS: VPI and MFV values were, respectively, 0.32 +/- 0.06 and 16.8 +/- 2.6 cm/second in the normal group, 0.27 +/- 0.07 and 14.2 +/- 2.2 cm/second in the group with grade 1 fatty infiltration, 0.22 +/- 0.06 and 12.2 +/- 1.8 cm/second in the group with grade 2 fatty infiltration, and 0.18 +/- 0.04 and 10.8 +/- 1.5 cm/second in the group with grade 3 fatty infiltration. There was a negative inverse correlation between the grade of fatty infiltration and both VPI (f = 55.3, p < 0.001) and MFV (f = 43.9, p < 0.001). CONCLUSION: The pulsatility index and mean velocity of the portal vein blood flow decrease as the severity of fatty infiltration increases.     

Value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis.

OBJECTIVE: The purpose of this study was to evaluate the value of Doppler sonography in assessing the progression of chronic viral hepatitis and in the diagnosis and grading of cirrhosis. METHODS: Abdominal sonographic and liver Doppler studies were performed in 3 groups: 36 patients with chronic viral hepatitis, 63 patients with cirrhosis, and 30 control subjects with no evidence of liver disease. A series of Doppler indices of hepatic vascularity, including portal vein velocity, portal vein pulsatility score, flow volume of the portal vein, resistive and pulsatility indices of the hepatic artery, modified hepatic index, hepatic vascular index, waveform of the hepatic vein, and focal acceleration of flow, were measured and correlated with liver and spleen size, portal and splenic vein diameter, and presence of ascites and collateral vessels. These indices were compared across the 3 study groups and within the patient groups with respect to presence of inflammation, fibrosis, and steatosis, as determined by histologic evaluation. RESULTS: The most useful indices were portal vein velocity, the modified hepatic index, and nontriphasic flow in the hepatic vein, which were helpful in distinguishing patients from control subjects. Hepatic vascular and modified hepatic indices were useful for differential diagnosis of cirrhosis and chronic viral hepatitis. However, all measurements were limited in their ability to determine the severity of chronic hepatitis. CONCLUSIONS: Doppler sonography is sensitive to hemodynamic alterations resulting from inflammation and fibrosis, and if sonography is the study of choice to follow the progression of hepatitis, it will not be adequate without Doppler imaging. Doppler sonography has high diagnostic accuracy in cirrhosis despite some false-positive conditions. However, it has a limited role in clinical grading.     

Portal vein pulsatility in normal and cirrhotic adults without cardiac disease

The literature indicates that Doppler demonstration of pulsatile flow in the portal vein suggests heart disease, and that retrograde transsinusoidal transmission of atrial pulsations is the mechanism. We noninvasively investigated portal vein pulsatility (PVP) in normal subjects and in patients with cardiac and liver disease, and performed invasive studies in cirrhotic humans and normal pigs. We found that accentuated PVP occurred in some normal subjects and in some patients with cirrhosis, and that mechanisms other than transsinusoidal transmission of atrial pulsations contributed to PVP. Determinants of PVP may include pulsatile portal inflow, transmission of pulsations from the vena cava (IVC) and location of the Doppler sample volume relative to the IVC. © 1995 John Wiley & Sons, Inc.     

彩色多普勒对人肝血管餐前、后血流动力学的研究

目的观测正常成人入肝血管(肝动脉、门静脉)餐前、后血流动力学改变,探讨其相互关系及其临床意义。方法应用彩色多普勒超声分别测量50例正常成人餐前、后入肝血管的血流参数,包括门静脉主干的直径(D),最大血流速度(Vmax),血流量(Q),肝右动脉的收缩期峰值速度(Vmax),舒张末期峰值速度(Vmin),时间平均速度(Vmean),阻力指数(RI),搏动指数(PI)等,探讨其相互关系。结果餐前肝右动脉和门静脉各主要血流参数分别为肝右动脉RI0.65±0.04,PI1.20±0.17,门静脉主干最高血流速度为(17.80±2.14)cm/s,血流量为(905.55±162.50)ml/min;餐后肝右动脉和门静脉各主要血流参数分别为肝右动脉RI0.73±0.04,PI1.74±0.51,门静脉主干最高血流速度为(22.40±3.25)cm/s,血流量为(1279.24±239.84)ml/min。结论餐前、后肝右动脉和门静脉各血流参数间存在显著差异(P＜0.05),肝动脉和门静脉血流量存在彼消此长的关系,以维持入肝血流的相对衡定。     

经颅多普勒检测主动脉瓣返流患者脑动脉血流变化

观察主动脉瓣返流患者脑动脉血流动力学变化。方法：选取观察组４６例,对照组５０例,采用彩色超声心动图、经颅多普勒分别观察心脏主动脉瓣返流性质和程度及其他情况,观察脑动脉血流动力学各项指数。结果观察组４６例,其中单纯主动脉瓣返流３４例,主动脉瓣返流伴二尖瓣病变１２例;对照列。     

Doppler ultrasound evaluation of advanced portal vein pulsatility in patients with normal echocardiograms

The hypothesis tested that mechanisms other than retrograde transsinusoidal fluid wave transfer reported in patients with right heart failure are responsible for the ultrasonographic sign of advanced portal vein pulsatility (APP). Within a time-period of 3 years we have seen 13 patients with APP, defined as temporary portal flow reversal in the face of a normal echocardiogram. Nine of these patients had biopsy-proven liver cirrhosis and four with liver disease were without cirrhosis or cardiac pathology. A randomly selected control group of 18 healthy subjects was studied. Doppler ultrasound evaluation of the hepatic veins as well as the intra and extrahepatic portal vein territories was performed in both groups. Hepatopetal portal flow with APP reversed to hepatofugal flow in follow up studies in two patients. In another two hepatopetal flow with APP in the main portal vein and hepatofugal flow in the intrahepatic portal radicles was recorded during the same examination. The remaining group displayed APP in the intra and extrahepatic portal vein territories. None of the normal subjects presented with APP. Hepatic venous outflow obstruction associated with excessive arterioportal shunting is likely to account for APP of all of our patients. Based on a causal link between angiographic ‘to-and-fro’ flow pattern and the sonographic APP sign in patients with sinusoidal outflow obstruction we suggest, that APP expresses a short, transitional period of portal hypertension just before the occurence of flow reversal.