肝移植血流动力学参数的变化及其临床意义

目的利用彩色多普勒超声检测移植肝血流动力学的参数,探讨参数变化的临床意义。方法利用彩色多普勒超声检测65例肝移植患者不同时期的肝动脉、肝静脉及门静脉的峰值血流速度(PS)、时间平均血流速度(TAV)、阻力指数(RI)及肝动脉血流灌注指数(DPI)。结果术后15d内,移植肝正常者门静脉TAV及肝动脉RI均明显高于对照组(P<0.05);肝动脉PS及DPI均明显低于对照组(P<0.05)。肝动脉血栓形成时,肝动脉PS明显降低,门静脉TAV明显增高,呈锯齿波。发生排斥反应时,门静脉TAV降低,肝动脉PS降低、RI增高,肝静脉三相波消失,呈锯齿波。结论利用彩色多普勒超声监测移植肝的血流动力学参数变化,可为移植肝的血管并发症及排斥反应的诊断提供辅助依据,且安全、无创。

The value of color Doppler ultrasonography for assessing liver transplantation and early diagnosis of complication by examining hemodynamic changes

Objective To discuss the value of color Doppler ultrasonography (CDUS) for (assessing) liver transplantation and early diagnosis of complication by examining hemodynamic changes.Methods Sixty-five cases subject to orthotopic liver transplantation (OLT) were examined by CDUS and following results were obtained, including peak systolic velocity (PS), resistance index (RI) and Doppler perfusion index (DPI) of the hepatic artery (HA), time average velocity (TAV) of portal vein (PV), as well as velocity of hepatic vein (HV) in three different stages after operation and 30 healthy subjects as control group.Results (1) In the patients without obvious complication, TAV of PV was increased (P<(0.05)), and PSV of HA decreased but RI risen as compared with those in control group (P<(0.05)) 15 days after operation. (2) When the hepatic artery thrombosis (HAT) (occurred), PS of HA and DPI was obviously decreased, but TAV of PV significantly increased as a high sawtooth wave. (3) While the livers of transplantation were rejected, TAV of PV and PS of HA were decreased, RI increased, and triphasic wave of HV disappeared.Conclusion The hemodynamic changes of PV, HA and HV in liver transplantation are valuable for assessing the liver of (transplantation) and early diagnosing the complication by CDUS.