脾切除贲门周围血管离断术对肝炎后肝硬化患者外周循环的影响

摘要

目的：探索脾切除贲门周围血管离断术对肝炎后肝硬化患者外周循环的影响。方法：行脾切除贲门周围血管离断术的肝炎后肝硬化患者20例为治疗组；无肝炎、肝硬化及脂肪肝的正常成人20例为对照组。采用无创心脏血流动力检测仪监测手术前后外周循环血流动力学参数，并分析手术对体循环的影响。结果：治疗组术前心率（HR）、平均动脉压（MAP）、每搏指数（SI）、每搏出量（SV）、外周循环阻力（SVR）、左心作功指数（LCWI）、左心作功（LCW）与对照组有差异，治疗组术前HR、SVR显著高于对照组，MAP、SI、SV、LCWI、LCW显著低于对照组；两组心输出量（CO）、心脏指数（CI）无统计学差异（P＞0.05）。治疗组手术前后9项指标均无显著性差异（P＞0.05）。但术后发生门静脉血栓的4例患者术后HR、SVR显著低于术前，SI、LCWI、LCW显著高于术前。结论：脾切贲门周围血管离断术增加了肝炎肝硬化患者的LCW及SI，降低了HR，使外周循环更趋于稳定。%Objective To investigate the effect on peripheral circulation of portal-azygous devasculariza-tion operation for patients with hepatitis-induced cirrhosis. Methods Twenty patients with cirrhosis caused by hepatitis in treatment group underwent portal-azygous devascularization operation;20 cases in control group were normal adults without hepatitis, cirrhosis nor fatty liver of 20 to 60 years age. Noninvasive cardiac hemody-namic detection appearance was applied to determine hemodynamic parameters of peripheral circulation in both groups and statistical methods were used to analyze the effect on systemic circulation. Results There was a significant difference(P<0.05)on HR,MAP,SL,SV,SVR, LCWI and LCW in the experimental group before opera-tion compared with those in the control group,HR and SVR were significantly higher than those in the control group,MAP,SI,SV,LCWI and LCW significantly lower than those in the control group;CO,CI had no significant difference(P>0.05), there was no significant difference(P>0.05)on nine indicators before and after surgery in the experimental group;but after excluding 4 patients with postoperative portal vein thrombosis and thrombolysis ineffective, there was a significant difference(P<0.05)in HR, SI, SVR, LCWI and LCW indicators in the experi-mental group before and after surgery, HR and SVR were significantly lower than the preoperative ones, SI, LC-WI and LCW significantly higher than the preoperative ones. Conclusion Portal-azygous devascularization operation increases stroke work and stroke volume,reduces heart rate,peripheral circulation tends to be more nor-mal physiologically.