肝硬化门静脉系统血流动力学改变的临床意义

目的：观察肝硬化门静脉系统血流动力学改变及其与食道静脉曲张程度、食道静脉曲张出血及肝功能分级的关系。方法：应用彩色多普勒超声检查比较60例肝硬化失代偿期患者和25例正常人的门脉血流动力学参数。结果：肝硬化患者门静脉、脾静脉直径增宽，血流速度下降，血流量增加，与对照组差异显著。各参数与食道静脉曲张程度无关。肝硬化出血组脾静脉血流动力学参数及脾静脉血流量／门静脉血流量比值较无出血组显著增高。Clild-Puph C级组患者门静脉流速及流量明显低于A级组、B级组。结论：肝硬化门脉血流动力学改变不能用于判断食道静脉曲张程度，但脾静脉内径、流速、流量及脾静脉血流量／门静脉血流量比值对预测食道静脉曲张出血有重要意义。门静脉流速、流量可反映肝功能损害情况。

Clinical significance of the changes of portal system hemodynamics in patients with cirrhosis

Objective To observe the changes of portal hemodynamics in cirrhotic patients and study the relationship between portal hemodynamics and the degree of upper gastrointestinal varicosity, portal hemodynamics and the Child Puph classification. Methods To compare the parameter of the portal system hemodynamics in sixty portal hypertensive cirrhotic patients and twenty five normal subjects by color doppler. Results Compared to normal control, the diameter of portal vein (Dpv) and splenic vein (Dsv) are significantly wider, the blood flow velocity of the portal vein(Vpv) and the splenic vein(Vsv) are significantly slower, the blood flow volume of the portal vein(Qpv) and splenic vein(Qsv) are significantly increased in cirrhotic patients. Each of the parameter isn't associated with upper gastrointestinal varicose degree. The parameter of splenic vein system hemodynamics and the ratio of splenic vein blood flow and portal vein blood flow are higher in cirrhosis patients with hemorrhage group than without hemorrhage group. Portal flow velocity and blood flow volume are significantly lower in Child Puph C group than Child Puph A and B group. Conclusion The changes of portal hemodynemics are not used to evaluate the degree of upper gastrointestinal varicosity, but the changes of Dsv, Vsv, Qsv and Qsv/Qpv are used to forecast upper gastrointestinal varicose hemorrhage. Vpv and Qpv can reflect the damage of liver function.