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在肝硬化等肝脏疾病的病程中,常伴有低氧血症等呼吸系统损害的并发症。肝肺综合征(Hepatopulmonary Syrdrome,HPS)是肝病时发生肺脏血管扩张和动脉氧合作用异常,可引起低氧血症,其实质乃是由于肺内毛细血管扩张,引起的肺泡对血液氧合障碍,在复杂的体液因子参与下的肺部可逆性病变。HPS作为一种肝病的并发症,早于1977年Kenned和Knudson就提出了这一概念,但当时未被认可。直到1988年Eriksson首先将肝硬化患者伴有肺内分流和肺内灌注障碍引起的低氧血症命名为功能性HPS。1989年Sherlock则将肝脏疾病所引起的各种肺部变化,包括低氧血症、肺内动-静脉分流、通气/血流比例失调、胸水、横膈肌上抬、肺底部不张、原发性肺动脉高压、门-肺静脉分流及胸片斑状阴影等,统称为HPS。目前,一般将中至重度低氧血症(PaO_2<10kPa)列入HPS。在除外心肺疾患的肝硬化患者中,其发生率达1/3,且远期预后不良。近年来,随着医学研究的发展,HPS这一新的概念逐渐被认识,并日益引起重视。现将HPS的有关研究进展综述如下。
Liver cirrhosis and other liver disease in the course of the disease, often accompanied by hypoxemia and other respiratory complications of complications. Hepatopulmonary Syrdrome (HPS) is an abnormal liver vasodilatation and arterial oxygenation, which can cause hypoxemia. The essence of HPS is the pulmonary alveolar obstruction caused by the expansion of pulmonary capillaries , Reversible lung disease with the involvement of complex humoral factors. HPS, a complication of liver disease, was proposed as early as 1977 by Kenned and Knudson but was not recognized at the time. Until 1988, Eriksson first named hypoxemia in cirrhotic patients with pulmonary shunt and intrapulmonary perfusion dysfunction as functional HPS. In 1989, Sherlock brought various lung changes caused by liver diseases, including hypoxemia, pulmonary arterio-venous shunt, imbalanced ventilation / blood flow, pleural effusion, diaphragmatic elevation, atelectasis in the lungs, Pulmonary hypertension, portal-pulmonary vein shunt and chest X-ray shadow, collectively referred to as HPS. Currently, moderate to severe hypoxemia (PaO 2 <10 kPa) is included in HPS. In patients with cirrhosis except cardiovascular disease, the incidence rate of 1/3, and the long-term prognosis is poor. In recent years, with the development of medical research, the new concept of HPS is gradually recognized and attracts more and more attention. Now HPS related research progress are summarized below.