彩色多普勒超声在肝门静脉高压血流动力学的应用

摘要

目的：运用彩色多普勒超声检测肝门静脉高压(PHT)的血流动力学变化，探讨其与肝功能Child-Pugh分级、食管静脉曲张(EV)程度的关系。方法：采用随机数表法选取100例确诊的肝硬化患者纳入肝硬化组，采用Child-Pugh分级标准进行肝功能分级，将100例肝硬化组患者分为A级、B级及C级，并采用胃镜了解EV程度；同时选取25名健康志愿者作为正常对照组；运用彩色多普勒超声探查125名受试者的门静脉系统。结果：肝硬化组与正常对照组相比，脾静脉内径增大，平均血流速度降低，脾静脉血流量增加，组间比较有差异(t=5.65，t=6.21， t=5.51；P＜0.05)；C级患者与A级和B级患者相比门静脉流速和血流量明显降低，组间比较有差异(t=0.98，t=5.22；P＜0.05)；EV程度越高，脾静脉内径越大，血流量增多，平均血流速度增大，组间比较有差异(t=3.63，t=3.17，t=3.78，t=3.92，t=2.43，t=2.07；P＜0.05)。结论：门静脉流速及门静脉血流量随肝功能恶化而明显下降；而EV程度与脾静脉内径、血流量成正相关。采用彩色多普勒超声检测门静脉血流动力学的改变可以判断肝功能的状况和EV的程度，具有重要的临床意义。%Objective:To observe the changes of portal hemodynamics in liver cirrhosis patients with color Doppler ultrasonography and to study the relationship between portal hemodynamics and the Child-Pugh classification as well as the degree of esophageal varicosity.Methods: 100 cases of patients with liver cirrhosis were randomly selected who were diagnosed in our hospital. According to the Child-Pugh classification, they were divided into in Child-Pugh A/B/C groups, and observed the degree of esophageal varicosity with the endoscopy. Meanwhile, we chose 25 cases of healthy volunteers as a control group. In 125 subjects, portal systemic hemodynamical parameters were studied with color Doppler ultrasonography.Results:Compared to the normal control group, the diameters of portal vein and splenic vein were higher than the cirrhosis group, while their flow velocity was lower, and there was a significant increase in splenic blood flow rate in cirrhotic patients. The difference was statistically significant (t=5.65, t=6.21,t=5.51;P<0.05). As for patients with different liver function, portal flow velocity and blood flow volume were lower in Child-Pugh C group than in Child-Pugh B and Child-Pugh A group, and the difference was statistically significant (t=0.98,t=5.22;P<0.05). The diameters and flow volume as well as blood flow rate of splenic vein and superior mesenteric vein were markedly higher in cirrhosis with the higher degree of esophageal varicosity, and the difference was statistically significant (t=3.63,t=3.17,t=3.78,t=3.92,t=2.43,t=2.07;P<0.05).Conclusion:Portal flow significantly decreases in cirrhotic patients with worsening Child-Pugh classification, and the degree of esophageal varicosity is associated with the increase of diameter and flow volume blood of splenic vein. The changes of portal hemodynamics in cirrhotic patients with color Doppler ultrasonography can estimate the condition of liver and the degree of EV, which is significant in clinical.