彩色多普勒检测老年肝硬化患者门脉血流动力学意义
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摘要
目的探讨彩色多普勒检测老年肝硬化患者门脉血流动力学改变的临床意义。方法 2016年2月—2018年2月,随机选取80例老年肝硬化患者为观察组,并根据Child-Pug h肝功能分级标准分为3组;再选取80例肝功能正常为对照组,对两组病例分别测量门静脉内径(DPV)、血流速度(VPV)、血流量(QPV)、脾静脉内径(DSV)、血流速度(VSV)、血流量(QSV)。并将观察组根据患者近两年病史,分为有出血史组和无出血史组,比较其门静脉、脾静脉内径。结果观察组肝硬化患者DPV平均值为(1.45±0.16)cm,对照组为(1.07±0.14)cm,差异有统计学意义(t=3.932,P <0.05)。观察组肝硬化患者DSV平均值为(1.3±0.08)cm,对照组为(0.72±0.10,差异有统计学意义(t=5.445,P <0.05)。观察组中不同肝功能分组间存在差异,观察组随着Child-Pugh肝功能分级A、B、C的升高, DPV、 DSV逐渐增宽,VPV、VSV逐渐减慢,差异有统计学意义(P<0.05)。观察组随着Child-Pugh肝功能分级A、B、C的升高,QPV增加不明显,差异无统计学意义(P>0.05)。有出血史组患者DPV、DSV大于无出血史组,差异有统计学意义(P<0.05)。结论老年肝硬化患者血流动力学变化与其肝功能分级相关,门静脉、脾静脉及肝功能分级为老年肝硬化并发出血的相关危险因素;彩色多普勒检测门脉血流动力学在评估患者门脉高压有重要临床意义,具有无创、可重复及较高准确性的优点。
Objective To investigate the clinical significance of color Doppler in detecting portal hemodynamic changes in elderly patients with cirrhosis. Methods From February 2016 to February 2018, 80 elderly patients with cirrhosis were randomly selected as observation group, and divided into 3 groups according to Child-Pug h liver function grading criteria. 80 patients with normal liver function were selected as control group. Portal vein diameter(DPV), blood flow velocity(VPV),blood flow(QPV), spleen vein diameter(DSV), blood flow velocity(VSV), and blood flow(QSV) were measured in the two groups. The observation group was divided into the hemorrhagic history group and the non-bleeding history group according to the patient's medical history in the past two years, and the inner diameter of the portal vein and splenic vein were compared. Results The mean DPV of the patients with cirrhosis was(1.45±0.16)cm in the observation group(1.07±0.14)cm in the control group. The difference was statistically significant(P <0.05). The mean DSV of the patients with cirrhosis was(1.3±0.08)cm in the observation group,(0.72±0.10)cm in the control group. The difference was statistically significant(t=5.445,P<0.05). There were differences in different liver function groups in the observation group with the increase of ChildPugh liver function grades A, B, and C, DPV and DSV gradually widened, and VPV and VSV gradually decreased, which the differece was statistically significant(P<0.05). With the increase of Child-Pugh liver function grades A, B, and C, the QPV increase was not significant, the differece was no statistical significance(P>0.05). Patients with hemorrhage history had higher DPV and DSV than those without hemorrhage, the differece was statistically significant(P<0.05). Conclusion The hemodynamic changes in elderly patients with cirrhosis are related to the grade of liver function. The portal vein, splenic vein and liver function are graded as the risk factors for cirrhosis in the elderly and blood. The color Doppler is used to detect the portal hemodynamics pulse hypertension, which has important clinical significance and has the advantages of noninvasive, repeatable and high accuracy.
Objective To investigate the clinical significance of color Doppler in detecting portal hemodynamic changes in elderly patients with cirrhosis. Methods From February 2016 to February 2018, 80 elderly patients with cirrhosis were randomly selected as observation group, and divided into 3 groups according to Child-Pug h liver function grading criteria. 80 patients with normal liver function were selected as control group. Portal vein diameter(DPV), blood flow velocity(VPV),blood flow(QPV), spleen vein diameter(DSV), blood flow velocity(VSV), and blood flow(QSV) were measured in the two groups. The observation group was divided into the hemorrhagic history group and the non-bleeding history group according to the patient's medical history in the past two years, and the inner diameter of the portal vein and splenic vein were compared. Results The mean DPV of the patients with cirrhosis was(1.45±0.16)cm in the observation group(1.07±0.14)cm in the control group. The difference was statistically significant(P <0.05). The mean DSV of the patients with cirrhosis was(1.3±0.08)cm in the observation group,(0.72±0.10)cm in the control group. The difference was statistically significant(t=5.445,P<0.05). There were differences in different liver function groups in the observation group with the increase of ChildPugh liver function grades A, B, and C, DPV and DSV gradually widened, and VPV and VSV gradually decreased, which the differece was statistically significant(P<0.05). With the increase of Child-Pugh liver function grades A, B, and C, the QPV increase was not significant, the differece was no statistical significance(P>0.05). Patients with hemorrhage history had higher DPV and DSV than those without hemorrhage, the differece was statistically significant(P<0.05). Conclusion The hemodynamic changes in elderly patients with cirrhosis are related to the grade of liver function. The portal vein, splenic vein and liver function are graded as the risk factors for cirrhosis in the elderly and blood. The color Doppler is used to detect the portal hemodynamics pulse hypertension, which has important clinical significance and has the advantages of noninvasive, repeatable and high accuracy.
引文
[1]宋月实,杨薇.腹部B超技术在诊断肝硬化门脉高压方面的临床价值探讨[J].当代医药论丛,2015,13(6):50-51.
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[6]Iwakiri Y,Shah V,Rockey DC.Vascular pathobiology in chro nic liver disease and cirrhosis-current status and future directions[J].Jhepatol,2014,61(4):912-924.
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[8]张静雯,时永全,韩英.肝硬化的治疗进展[J].临床肝胆病杂志,2015,31(3):465-468.
[9]王凤梅.彩超对肝硬化代偿和失代偿期肝癌术前及术后诊断价值分析[J].世界最医学信息文摘:连续型电子期201515(74):218-219.
[10]尹玲,阮骊韬,高良.彩色多普勒超声检测肝硬化患者门、脾静脉血流动力学的临床意义[J].现代消化及介入治疗2017,22(4):468-471.
[11]刘斌,方正亚,孟冬梅,等.肝硬化并发症治疗及预防研究进展[J]中华实用诊断与治疗杂志,2016,30(12):1152-1155.
[2]Tsochatzis EA,Bosch J,Burroughs AK.Livercirrhosis[J].Lancet2014,383:1749-1761.
[3]黄书晖.彩色多普勒超声在肝硬化患者上消化道出血预测中的临床应用.[J]辽宁医学院学报,2016,37(4):33-35.
[4]徐进.老年肝硬化病因及临床特点分析[J].华西医学,2016,31(7):1209-1212.
[5]陈新燕,门永忠,吴永娟.慢性乙型肝炎与肝硬化患者胆囊病变的B超分析[J].中华医院感染学杂志,2015,25(5):1103-1105.
[6]Iwakiri Y,Shah V,Rockey DC.Vascular pathobiology in chro nic liver disease and cirrhosis-current status and future directions[J].Jhepatol,2014,61(4):912-924.
[7]黄萍,陈明锴.门脉高压症肝内外血管病变的研究进展[J]医学研究杂志,2016,45(1):8-9.
[8]张静雯,时永全,韩英.肝硬化的治疗进展[J].临床肝胆病杂志,2015,31(3):465-468.
[9]王凤梅.彩超对肝硬化代偿和失代偿期肝癌术前及术后诊断价值分析[J].世界最医学信息文摘:连续型电子期201515(74):218-219.
[10]尹玲,阮骊韬,高良.彩色多普勒超声检测肝硬化患者门、脾静脉血流动力学的临床意义[J].现代消化及介入治疗2017,22(4):468-471.
[11]刘斌,方正亚,孟冬梅,等.肝硬化并发症治疗及预防研究进展[J]中华实用诊断与治疗杂志,2016,30(12):1152-1155.