术前高压氧治疗对肝硬化门静脉高压症病人的影响

目的 研究术前高压氧（HBO）治疗对肝硬化门静脉高压病人的作用，并探讨其机理。方法 选取肝硬化门静脉高压病人12例接受HBO治疗。观察肝功指标、内毒素和NO水平、肠粘膜通透性、网状内皮系统功能及血流动力学指标在HBO前后变化；另设正常对照组8例，比较两组间肠粘膜通透性、网状内皮系统功能的差异。结果 （1）与正常秩序正常组相比，肝硬化组的肠粘膜通透性增高，而网状内皮系统吞噬功能降低，且内毒素与肠粘膜通透性呈正相关（r＝0．504，P＝0．012）。（2）HBO治疗后，病人的肝功改善；网状内皮系统功能恢复，内毒素、NO较前下降；脾脏厚度、门静脉宽度及门静脉血流量减少。（3）统计分析发现NO与内毒素、脾脏厚度及门静脉血流速度呈正相关（r1＝0．597，P1＝0．000；r2＝0．472，P2＝0．027;r3＝0．463，P3＝0．030），与门静脉血流速度呈负相关（r＝－0．443，P＝0．030）。结论 HBO能改善肝硬化病人的肝脏功能，改善门静脉高压和高动力循环状态。其作用机理可能与改善肝脏供氧，增加网状内皮系统功能，减少血中内毒素及NO有关。

Effects of preoperative hyperbaric oxygen therapy on cirrhotic patients with portal hypertension

Objective To investigate the effects of hyperbaric oxygen (HBO) therapy on cirrhotic patients with portal hypertension during the preoperative period and explore its mechanism. Methods Twelve cirrhotic patients with portal hypertension (cirrhotic group) were chosen to receive HBO therapy. Indices of liver function, levels of NO and endotoxin, parameters of hemodynamics, function of reticulo-endothelial phagocytosis and permeability of intestinal mucosa were measured before and after the therapy. A group of healthy volunteers were chosen to serve as the controls (n=8, control group). The reticulo-endothelial phagocytic function and intestinal mucosal permeability in the control group were also measured and compared with those in the cirrhotic group. Results (1) The cirrhotic group showed a significant increase in intestinal mucosal permeability and decrease in reticulo-endothelial phagocytic function. Endotoxin was found to be significantly correlated to intestinal mucosal permeability (r=0 504, P=0 012). (2) After HBO therapy, there were a significant improvement in liver function, reticulo-endothelial phagocytic function and a decrease in levels of NO and endotoxin, the thickness of spleen, the diameter and blood flow of portal vein in cirrhotic group. (3) NO was positively correlated with endotoxin (r=0 597, P=0 000), the thickness of spleen (r=0 472, P=0 027) and the blood flow of portal vein (r=0 463, P=0 030) but negatively correlated to the blood velocity of portal vein (r=-0 443, P=0 030). Conclusions HBO therapy can improve liver function and alleviate portal hypertension and hyperdynamic circulation. Its mechanism might be to improve the oxygen supply to hepatic tissues, enhance reticulo-endothelial phagocytic function and reduce the concentration of NO and endotoxin in systemic circulation.