生长抑素对肝硬变门静脉高压症患者门静脉、肝静脉血流和门静脉压力的影响  

Effect of somatostatin on portal and hepatic hemodynamics and portal venous pressure in cirrhotic patients with portal hypertension

作　　者：朱继业[1] 冷希圣[1] 冯洪强[1] 李澍[1] 甘丽云 张颖[1] 杜如昱[1] 

机构地区：[1]北京医科大学人民医院外科

出　　处：《中华外科杂志》1998年第7期433-435,共3页Chinese Journal of Surgery

基　　金：国家自然科学基金;卫生部科学研究基金

摘　　要：目的了解生长抑素对肝硬变门静脉高压症患者门静脉、肝静脉血液动力学及门静脉压力的影响。方法用彩色多普勒超声系统测定了２０例肝硬变门静脉高压症患者使用生长抑素前后门静脉主干及左、中、右３支肝静脉的内径、最大血流速率及其血流量。其中１５例患者测定使用生长抑素前后门静脉压力的变化。结果１５例患者使用生长抑素后１、１．５小时，门静脉压力由用药前的２．７７±０．２６ｋＰａ下降至２．４２±０．２７ｋＰａ和２．４０±０．２７ｋＰａ（Ｐ＜０．０１）；用药后患者动脉收缩压，舒张压及心率无显著变化。２０例患者门静脉截面积在应用生长抑素后缩小７．２８％，但差异无显著意义。门静脉最大血流速率由用药前的１９．７２±７．７５ｃｍ／ｓｅｃ下降至用药后的１５．９８±７．２６ｃｍ／ｓｅｃ，下降了１８．９６％（Ｐ＜０．０１）。用药后３支肝静脉平均总血流量由１７８６．２２±９２６．３７ｍｌ／ｍｉｎ增加至１８３６．１７±８４４．２４ｍｌ／ｍｉｎ，但差异无显著意义（Ｐ＞０．０５）。结论周围静脉持续点滴生长抑素可持续降低门静脉压力。生长抑素降低门静脉压力的机制可能是通过降低门静脉血流速率从而降低门静脉血流量，而不是直接收缩门静脉的结果。Objective To investigate the effect of somatostatin on hepatic and portal hemodynamics and portal venous pressure in cirrhotic patients with portal hypertension. Method Colorful doppler ultrsonography was used to measure the diameter and maxinum hemokinetic velocity of portal vein and hepatic vein before and after intravenous administration somatostatin,and thus their hemokinetic volume was calculated respectively.Among 15 surgical patients, changes of the portal venous pressure were observed via a catheter before and after the administration of somatostatin.Result One hour and 15 hour after the administration, the pressure of portal vein significantly decreased from 277± 026 kPa to 242± 027 kPa and 240±027 kPa,respectively (P<001).The systolic pressure, diastolic pressure and heart rate showed no significant changes. After the administration,the sectional area of portal vein decreased by 728% but without significance.The maximum hemokinetic velocity of portal vein significantly decreased by 1896% (from 1972±775 cm/sec to 1598±726 cm/sec,P<001). The mean total hemokinetic volume increased from 178622±92637 ml/min to 183617± 84424 ml/min, but without significance(P>005). Conclusion Continous instillation of somatosatin via peripheral vein can decrease the portal venous pressure in cirrhotic patients with portal hypertension. The mechanism may be the decrease of hemokinetic volume caused by the decrease of hemokinetic velocity of the portal vein.

关 键 词：门脉高压症 血流 门静脉 肝静脉 生长抑素 

分 类 号：R657.34[医药卫生—外科学]