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目的探讨卡维地洛对肝硬化患者门静脉系统血流动力学及肝静脉压力梯度(HVPG)的影响,为卡维地洛治疗门静脉高压的临床应用提供依据。方法入选2010年3月至2011年3月山东省立医院肝硬化门静脉高压合并食管胃静脉曲张患者33例,分别于卡维地洛治疗前、治疗1周后行HVPG测定及门静脉彩色多普勒血流动力学指标检测。结果 30例患者完成治疗前后的HVPG和门静脉系统超声血流动力学指标观察。该30例患者卡维地洛治疗前HVPG(13.02±4.49)mm Hg,1周后降至(10.62±4.86)mm Hg,差异有统计学意义(P=0.002);其中40%(12例)患者HVPG降低至12 mm Hg以下或者HVPG降低幅度达基础值的20%以上。卡维地洛治疗前后门静脉主干内径(DPV)、门静脉主干血流速度(VPV)、门静脉主干血流量(QPV)、脾静脉血流速度(VSV)、脾静脉血流量(QSV)均显著降低(P<0.05),而脾静脉内径(DSV),肠系膜上静脉内径(DSMV)、血流速度(VSMV)和血流量(QSMV)变化无统计学意义(P>0.05)。有3例患者出现低血压、头晕,其中1例不耐受而停药退出临床试验;未发现哮喘、房室传导阻滞等其他严重不良反应。结论卡维地洛能显著降低肝硬化患者脾静脉和门静脉主干的血流速度和血流量,从而减少门静脉系统的血流灌注,显著降低HVPG,具有潜在的预防静脉曲张破裂出血的应用前景。
Objective To investigate the effects of carvedilol on portal hemodynamics and hepatic venous pressure gradient (HVPG) in patients with cirrhosis and provide basis for the clinical application of carvedilol in treating portal hypertension. Methods From March 2010 to March 2011, 33 patients with portal hypertension and esophagogastric varices were enrolled in Shandong Provincial Hospital from March 2010 to March 2011. HVPG and portal vein color Doppler flow imaging were performed before treatment and 1 week after carvedilol treatment respectively. Kinetic index detection. Results 30 cases of patients completed the treatment of HVPG and portal vein ultrasound system hemodynamic indicators. In the 30 patients, the HVPG (13.02 ± 4.49) mm Hg before treatment was decreased to (10.62 ± 4.86) mm Hg after 1 week and the difference was statistically significant (P = 0.002); 40% (12 cases) The patient’s HVPG was reduced to less than 12 mm Hg or HVPG was reduced by more than 20% of the baseline value. Before and after the carvedilol treatment, the main diameter of the portal vein (DPV), the main portal vein velocity (VPV), the main portal vein blood flow (QPV), the splenic vein velocity (VSV) and the splenic vein blood flow (QSV) There were no significant differences in DSV, DSMV, VSMV and QSMV between the two groups (P> 0.05). In 3 patients, hypotension and dizziness occurred. One patient was intolerant and was withdrawn from clinical trials. No other serious adverse reactions such as asthma and atrioventricular block were found. Conclusion Carvedilol can significantly reduce the splenic and portal vein blood flow velocity and blood flow in cirrhotic patients, so as to reduce the perfusion of portal vein system and significantly reduce HVPG, which has potential application in preventing variceal bleeding.