门静脉高压症患者分流术围手术期血浆内皮素水平变化的意义

目的测定肝硬化门静脉高压症患者远端脾肾分流手术围手术期内皮素1(ET-1)水平。方法收集住我院肝炎后肝硬化患者共40例的临床资料,分为门静脉高压组20例和肝硬化组20例,另以健康成年人15例作为对照组。肝硬化组与对照组空腹采血4ml,门静脉高压组在术前48 h、术后24 h、72 h和7 d分别空腹采肘静脉血4 ml,用放射性免疫方法测定内皮素1浓度,并测术中及术后各相应时段的门静脉压力。结果手术前、后门静脉高压组患者外周血ET-1浓度均明显高于对照组(P<0.01);手术前后差异有统计学意义(P<0.05)。门静脉高压组手术前与肝硬化组外周血ET-1浓度比较差异有统计学意义(P<0.05)。ET-1水平下降与门静脉压下降呈正相关(r=0.16,P=0.034)。结论ET-1水平的增高可能对门静脉血管阻力的增加有影响,远端脾肾分流手术可降低门静脉压力,从而使ET水平呈下降趋势。ET可能在肝硬化门静脉高压症的形成中有意义。

Significance of the Plasma ET Change of the Perioperative Period in Patients with Portal Hypertension afterDistal Splenorenal Shunt

Objective:To detect the plasma ET of the perioperative period in the cirrhotic patients with portal hypertension after distal splenorenal shunt.Methods: 40 patients with the hepatitic cirhosis after hepatitis B were detected and divided into two groups: 20 patients with the portal hypertension and 20 patients with the hepatitic cirhosis and compared with 15 healthy persons.4ml blood via lubital vein was collected seperately 48h before operation,24h,72h,7days after distal splenorenal shunt in portal hypertension group and 4ml blood were collected in the control group and hepatitic cirhosis group.The plasma ET was detected by using the radioimmunoassay.Compared with control group and hepatitic cirhosis group,cubital venous plasma ET levels significantly increased in portal hypertension group patients before surgery,(P<0.01 and P<0.05) seperately.Compared with the control group,cubital venous plasma ET levels significantly increased in portal hypertension group after surgery(P<0.01).The comparison before and after surgery had significant difference in portal hypertension group(P<0.05) and the decreasion of plasma ET levels was in proportion to the decrease of the portal pression(r=0.16,P=0.034).Conclusion: The plasma ET has influence on the formation of the portal hypertension.The distal splenorenal shunt can decrease the pressure of the portal vein and can decrease the plasma ET levels.Perhaps ET has effect on the formation of portal hypertension.