Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

Surgical therapy for portal hypertension in patients with cirrhosis in China: present situation and prospects

Surgical therapy for portal hypertension (PHT) in patients with cirrhosis has long been controversial,and various operative approaches have been used to prevent or manage such lethal complications as gastroesophageal variceal hemorrhage. However, over a century various portazygos devascularization and shunt approaches have been developed or modified, but the therapeutic effects have not been satisfactory till 1963 when Starzl did the first liver transplantation in the world, which provides a new hope to the surgical treatment of PHT.     

RhoA/Rho激酶信号途径在门静脉高压发病机制中的研究进展

门静脉高压(PHT)是肝硬化后期的一个重要并发症,其引起的上消化道出血、脾大、腹腔积液、侧支循环形成严重影响患者的生存质量。由于PHT发病机制复杂、肝内和肝外存在诸多矛盾,导致临床上缺乏有效治疗PHT的药物,这也是目前PHT治疗的瓶颈问题之一。因此,深入研究PHT的形成机制,开发安全有效、不良反应少的药物一直是该领域的研究热点。调节血管收缩的Rho A/Rho激酶信号途径异常可能是PHT形成的关键机制之一。该文总结了近年来Rho A/Rho激酶信号途径在PHT发病机制中的研究进展,旨在为开发治疗PHT的药物提供新思路。     

系统性硬化病合并肺动脉高压临床特点和治疗

目的探讨系统性硬化病(SSc)合并肺动脉高压(PHT)的临床特点、治疗方法和预后。方法回顾性研究28例SSc合并PHT患者的临床特点,实验室检查以及治疗后病情变化,并与73例未合并PHT的SSc患者进行比较。结果28例SSc合并PHT患者中,21例为血管源性PHT,7例为严重肺纤维化导致的肺源性PHT。与未合并PHT患者血清中白蛋白、γ-球蛋白、IgA、IgG以及C反应蛋白(CRP)水平间差别均有显著性意义(P<0.05)。肢端溃疡/指端凹陷性瘢痕、肌酶升高、肾脏受累、食管钡餐及ECG异常的发生率及ANA、抗RNP抗体阳性率间差别均有显著性意义(P<0.05)。结论上述指标有助于发现合并PHT的可能性;PHT是SSc的一个严重并发症,多伴有其他脏器损害,预后不良,应尽早采取综合治疗,尤其是针对原发病和诱因的强化治疗,血管扩张剂(主要是钙离子阻滞剂)和抗凝剂是治疗PHT的基本药物,病情顽固患者用前列环素制剂可改善预后。     

542例抗痫药副作用的前瞻性研究

本文报告对５４２例癫痫病人抗痫药毒副反应的前瞻性研究结果。在抗痫治疗的１０年中，有９５例（１７．５３％）病人出现没的毒副反应。其中，苯妥英的毒副反应发生率为４６．５７％、卡马西平的发生率为９．６２％、丙戊酸为７．１０％、苯巴比妥为９．６２％。毒副反应中最常见见的是皮诊，共济失调、眼球震颤及胃肠道症状，有３例病人出现明显肝功能损伤。本文还讨论了毒副反应的发生规律及其对策。     

钙调蛋白在门静脉高压内脏高动力循环中的作用

目的：检测钙调蛋白（calmodulin,CaM）在肝硬化门静脉高压（portal hypertension,PHT）的大鼠内脏动脉中的表达变化,探讨其在肝硬化PHT高动力循环中的作用及可能的机制。方法：检测并比较对照组（ n＝8）和四氯化碳（CCl4）诱导的肝硬化PHT组（n＝8）大鼠的门静脉血流量、门静脉压力、离体肠系膜微动脉对去甲肾上腺素（ norepinephrine ,NE）的反应性,CaM特异性抑制剂W-7对离体肠系膜微动脉收缩反应性、各组大鼠肠系膜动脉CaM和磷酸化内皮型一氧化氮合酶（ phosphorylation of endothelial nitric oxide synthase , p-eNOS）的蛋白表达变化的影响。结果：（1） PHT组门静脉血流量明显低于对照组,W-7对PHT组门静脉血流量无明显改善作用;（2） PHT组门静脉压力明显高于对照组,W-7对PHT组门静脉压力亦无明显降低作用;（3） PHT组肠系膜微动脉对NE的收缩反应性明显降低,EC50明显增大,W-7能部分改善这种低反应性;（4） PHT组肠系膜动脉内CaM和p-eNOS的蛋白水平较对照组明显升高,W-7能明显降低PHT组肠系膜动脉内p-eNOS的蛋白表达。结论：CCl4诱导肝硬化PHT大鼠肠系膜动脉中过度生成的CaM可能通过参与或协同生成p-eNOS等方式来促进eNOS的活性增加,最终促进一氧化氮（nitric oxide,NO）的生物合成,降低肠系膜微动脉对NE的反应性,并引起内脏血管扩张,参与内脏高动力循环的形成。     

布-加综合征和肝内型门静脉高压症患者血流动力学比较

目的:探讨布-加综合征(Budd-Chiarisyndrome,B-CS)及肝内型门静脉高压症(portalhypertension,PHT)患者血流动力学变化之间的差异。方法:利用彩色多普勒超声对40例B-CS患者、24例PHT患者和24名正常人的门静脉(PV)内径和平均血流速度、每min血流量(Q)进行测算,同时观察肝静脉(HV)、下腔静脉(IVC)变化和肝内侧支血管的形成情况等。以24例健康者为正常对照。结果:B-CS组及PHT组PV内径均大于正常对照组(P均<0.05),PV平均血流速度和Q均小于正常对照组(P均<0.05)。B-CS组上述3指标均小于PHT组(P均<0.05)。B-CS组患者HV病变38例(95%),表现为开口闭塞或狭窄,远端扩张、迂曲等;PHT组发现HV轻度受压狭窄10例(41.7%),HV显示不清3例(12.5%);正常对照组HV均显示正常。IVC病变24例(60%),主要表现为IVC膜性阻塞、狭窄、闭塞,阻塞下方有血栓和IVC扩张,IVC壁搏动消失,血流速度加快、呈双向和逆流等;PHT组发现IVC轻度狭窄8例(33.3%),余正常;正常对照组IVC显示正常。B-CS组特征性的肝内侧支血管形成,表现为HV之间的交通支开放,副肝静脉扩张等;PHT组和正常对照组未发现肝内侧支。结论:B-CS涉及多支HV、PV和IVC系统,患者存在复杂的血流动力学变化。肝内侧支出现是B-CS区别于PHT的特征性表现。     

门静脉高压症并上消化道出血的介入治疗进展

门静脉高压症并上消化道出血主要由食管胃底静脉曲张破裂引起,是门静脉高压最危急的并发症。常致患者失血性休克,加重肝细胞损害、诱发腹水和肝性脑病,危及患者生命。介入治疗与传统外科手术相比,围术期风险低、并发症发生率低、病死率较低,近年逐渐成为治疗该症的主要技术手段。各种介入方法原理和路径不同,优缺点和难易程度各异,介入医师应该充分认识,并根据临床情况进行选择。现就该症的介入治疗技术及其研究进展进行综述。     

焦虑对急性心肌梗死患者院前延误时间的影响

背景　急性心肌梗死（AMI）患者院前延误时间（PHT）延长是影响救治效果的主要因素。现关于PHT的研究越来越多,但多集中在社会人口学因素、AMI临床症状、发病情景、认知等层面,而缺乏对社会心理因素的系统研究。焦虑是AMI患者常见心理问题,但在中国人群中其是否影响AMI患者PHT尚未见相关报道。目的　探究焦虑对AMI患者PHT的影响,以期为AMI伴焦虑患者院前延误干预策略的制订提供依据。方法　本研究为多中心横断面研究,连续选取2016年4月—2017年2月于上海市4家医院（同济大学附属同济医院、同济大学附属第十人民医院、上海市杨浦区中心医院和解放军第411医院）就诊的AMI住院患者265例为研究对象。收集患者一般资料、AMI发病时症状、决定时间、转运时间、PHT（患者发病至到达医院的时间）,采用广泛性焦虑障碍量表（GAD-7）评估患者焦虑情况。结果　265例患者的PHT为150.0（70.0,501.0）min;焦虑评估结果：无焦虑161例,有焦虑104例（其中轻度焦虑81例,中度焦虑16例,重度焦虑7例）。有焦虑患者抑郁、心脏否认发生率及怕死程度得分高于无焦虑患者（P<0.05）。有焦虑患者濒死感、头晕发生率高于无焦虑患者（P<0.05）。无焦虑与有焦虑患者决定时间、转运时间、PHT比较,差异无统计学意义（P>0.05）。重度焦虑患者决定时间、PHT长于轻度焦虑患者（P<0.05）;不同焦虑程度患者转运时间比较,差异无统计学意义（P>0.05）。结论　AMI伴焦虑患者更易发生抑郁、心脏否认,重度焦虑患者较轻度焦虑患者决定时间、PHT更长,从而更可能错过最佳再灌注治疗时间,影响预后。     

普朗尼克P85与维拉帕米对苯妥英钠脑靶向分布的比较

【目的】 比较表面活性剂普朗尼克P85和维拉帕米对传统抗癫痫药物苯妥英钠的脑靶向分布作用?【方法】 健康雌性Sprague-Dawley大鼠,25只,周龄9~10周,体质量190~240 g,随机分为5组,每组5只?具体为PHT组?+VPM组?+0.1%P85组?+1%P85组?+10%P85组?PHT组静脉注射苯妥英钠;+VPM组静脉注射苯妥英钠前30 min腹腔注射维拉帕米;+0.1%P85组?+1%P85组和+10%P85组静脉注射的苯妥英钠用相应浓度的普朗尼克P85溶液配制?给予苯妥英钠后分别在不同时间点取大脑微透析液和血液,最后处死大鼠分离肝脏和肾脏组织?高效液相色谱法检测各样本中苯妥英钠的浓度,评估苯妥英钠的脑靶向分布情况? 【结果】 +10%P85组?+1%P85组?+0.1%P85组和+VPM组与PHT组比较,脑组织间液和血浆苯妥英钠的曲线下面积比值分别提高113.5%?50.4%?21.9%和7.2%,各组之间两两比较差异均有统计学意义?+VPM组苯妥英钠药物浓度肝血比明显升高,与其余各组之间差异有统计学意义?各组苯妥英钠药物浓度肾血比之间比较,差异无统计学意义?【结论】 相对于维拉帕米,普朗尼克P85可明显的提高苯妥英钠进入大脑的剂量,而且不会提高苯妥英钠在肝脏和肾脏的累积分布,具有脑靶向输送作用?     

慢性肺心病肺动脉高压影响因素的探讨

作者观察了289例肺心病急性期患者低氧血症,高碳酸血症及PCV和BV增高对PPA的影响,结果78.9％患者PPA均有不同程度升高,其PPA值与PaO_2呈负相关,与PaCO_2,PCV及BV呈正相关。缺氧、酸中毒和BV增高均为引起PHT的可逆性因素,故长程氧疗,纠正酸中毒和改善高粘血症对防治肺心病PHT方面具有重要的意义。     

肝前型门静脉高压大鼠胃粘膜循环动力学的研究

目的观察肝前型门静脉高压大鼠胃粘膜循环动力学改变，并对有关调节因素进行探讨。方法按不同程度缩窄大鼠门静脉主干，造成肝前型门静脉高压模型，使用放射微球法对４３只大鼠胃粘膜血流动力学改变进行观察。结果门静脉高压大鼠胃粘膜血流明显减少，粘膜下层、肌层血流明显增加；胃粘膜微血管阻力明显升高，而粘膜下层、肌层阻力下降；胃粘膜血流量与门静脉压力之间存在明显负相关。结论肝前型门静脉高压大鼠胃粘膜呈低灌流状态，胃粘膜血流减少与门静脉压力升高、粘膜微血管阻力增加有关。     

慢性炎症性肺动脉高压大鼠肺动脉蛋白激酶C的活性变化

目的 观察慢性炎症性肺动脉高压大鼠在肺动脉高压形成过程中肺动脉蛋白激酶C(PKC)的活性变化.方法 建立野百合碱诱导的慢性炎症性肺动脉高压大鼠模型,采用同位素标记的放射活性测定法检测肺动脉高压形成过程中肺动脉蛋白激酶C的活性.结果 随着慢性炎症性肺动脉高压的进展,大鼠肺动脉PKC总活性和胞浆PKC活性先是逐渐上升,而后逐渐下降(与对照组相比,P＜0.05),但胞膜PKC活性和PKC活性的膜质比持续上升(与对照组相比,P＜0.05).结论 PKC活性的上调和PKC的转位活化可能参与了慢性炎症性肺动脉高压的形成过程.