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目的 探讨肝硬化门脉高压症血流动力学变化及其与食管静脉曲张出血 (EVB)的关系。方法 运用彩色多普勒流速剖面 (CDVP)技术检测 69例肝硬化门脉高压症患者和 46例正常人门静脉主干 (PT )、右前支 (RAB)及脾静脉 (SV)的最大截面平均流速 (CS Vmax)、流量、瘀血指数 (CI)、剖面参数n值和流量历时变化曲线 ,比较EVB史阳性和阴性两组间的血流动力学差异 ,多元线性回归分析与EVB相关的因素。结果 肝硬化组PT、RAB的CS Vmax较正常组显著减低 ,PT、SV的流量及SV与PT流量比 (SV/PT)较正常组显著增高 ,PT、RAB及SV的CI均较正常组显著增高 ,流量变化曲线在肝硬化组RAB恒定型增多 ,SV周期变化型增多。肝硬化EVB阳性组与阴性组相比 ,PT的n值显著低下 ,SV流量、SV/PT及脾大小均显著增高 ,多元线性回归分析发现PT的n值和SV/PT是与EVB相关的两个独立因素。结论 肝硬化时门静脉系处于阻力增高和高动力循环并存状态 ,但在不同的血管有不同的表现侧重 ,大体形成了血管愈趋向肝脏血流阻力愈大 ,愈远离肝脏高动力循环愈明显的规律。SV高动力循环是门脉血流量增加的主要来源 ,是触发出血的危险因子。SV/PT流量比和PT的n值可望成为EVB的预测指标。
Objective To investigate the changes of hemodynamics in cirrhotic patients with portal hypertension and its relationship with esophageal variceal bleeding (EVB). Methods The color Doppler flow velocity profile (CDVP) was used to detect the maximum average cross-sectional velocity of the portal vein (PT), right anterior branch (RAB) and splenic vein (SV) in 69 cirrhotic patients with portal hypertension and 46 healthy controls CS Vmax, flow rate, blood stasis index (CI), profile parameter n and flow duration were recorded. The hemodynamic differences between positive and negative EVB history were compared. Multiple linear regression analysis was used to analyze EVB related factors. Results The CS Vmax of PT and RAB in cirrhotic patients were significantly lower than those in normal controls (P <0.05). The flow rates of PT, SV and SV / PT of SV and PT were significantly higher than those of normal group Increased, the flow curve of cirrhosis in the RAB constant type increased, SV cycle changes increased. Compared with the negative group, the n value of PT in cirrhotic EVB positive group was significantly lower, the SV flow volume, SV / PT and spleen size were significantly increased. The multivariate linear regression analysis found that the n value of PT and SV / PT were correlated with EVB An independent factor. Conclusions In the cirrhotic patients, the portal vein is in the coexistence of high resistance and hyperdynamic circulation. However, it has different manifestations in different blood vessels. It generally forms the rule that the blood vessels become more resistant to the blood flow of the liver and the farther away from the hyperdynamic circulation of the liver . SV hyperdynamic circulation is the main source of increased portal blood flow and is a risk factor for triggering bleeding. SV / PT flow ratio and PT n value is expected to become a predictor of EVB.