TIPSS 对门静脉高压患者左心室和肺血管的影响

Effect of TIPSS on left ventricule and pulmonary vessels in patients with portal hypertension

摘要:

目的 探讨经颈静脉肝内门体腔静脉内支架分流术（TIPSS）对门静脉高压患者左心室和肺血管 舒张的影响。方法 选取2005 年1 月-2012 年12 月于陕西省中医医院介入科住院的门静脉高压患者46 例 作为研究对象。其中，26 例行TIPSS，20 例行脾切断流术（EGDS）。对所有患者在术前及随访结束时行生化 指标检测、心脏彩色多普勒超声检查及肺血管舒张试验。结果 两组患者白细胞、血小板、血红蛋白、丙氨 酸转氨酶、天冬氨酸转氨酶、γ- 谷氨酰转肽酶、碱性磷酸酶、血尿素、肌酸酐（Cr）、血清总蛋白、白蛋 白、计算凝血酶原时间及部分凝血活酶时间无差异（P >0.05），但在总胆红素及间接胆红素有差异（P <0.05）。 TIPSS 组8 例肺血管舒张，EGDS 组6 例肺血管舒张，两者比较无差异（P >0.05）。心脏彩超检查结果提示， TIPSS 组患者术后左心房前后径、左室舒张末内径、左室舒张末容积、左室收缩末内径、左室收缩末容积的 增幅大于EGDS 组（P <0.05），收缩分数、左心室射血分数降幅高于EGDS 组（P <0.05）。TIPSS 组患者术后 心搏出量、左心室每分钟搏出量的增幅高于EGDS 组（P <0.05）。结论 TIPSS 对门静脉高压患者左心室功 能有显著影响，具体机制和长期作用，有待进一步研究和随访观察。

Abstract:

Objective To investigate the effect of transjugular intrahepatic portosystemic stent shunt (TIPSS) on left ventricule and pulmonary vasodilatation in patients with portal hypertension. Methods Forty-six patients with portal hypertension were selected in our hospital from January 2005 to December 2012 were selected as the objects of study. Among them 26 cases were given TIPSS, and 20 cases underwent splenectomy and devascularization (EGDS). Before operation and after the end of the follow-up, the biochemical indexes were detected, and cardiac color Doppler ultrasonography was performed in the patients. All patients underwented pulmonary artery relaxation test at the end of the follow-up. Results After follow-up, WBC, PLT, Hb, ALT, AST, GGT, ALP, BUN, Cr, TP, ALB, PT or PTT of the two groups was not significantly different (P > 0.05), but the differences in TB and IB were significant betwen the two groups (P < 0.05). There were 8 cases of pulmonary artery relaxation in the TIPSS group, and 6 cases of pulmonary artery relaxation in the EGDS group, the difference was not significant (P > 0.05). After operation, cardiac color Doppler demonstrated that the increases of LA, LVEDD, LVEDV, LVESD and LVESV in the TIPSS group were less, and the increases of SF and EF in the TIPSS group were more than those in the EGDS group (P < 0.05). As to the hemodynamic parameters, CO and SV of the TIPSS group increased more than those of the EGDS group (P < 0.05). Conclusions TIPSS has significant effect on left ventricular function in patients with portal hypertension, but has no effect on pulmonary vascular relaxation. Specific mechanisms and long-term effect need further study and follow-up observation.