超声检测ICU肝性脑病患者门静脉血流动力学的临床价值  

Clinical value of portal vein hemodynamics by color Doppler ultrasound for hepatic encephalopathy patients in ICU

作　　者：尹智[1] 朱勇[2] 张中伟[3] 王文虎[1] 林和[1] 

机构地区：[1]资中县人民医院重症医学科,四川资中641200 [2]资中县人民医院超声医学科,四川资中641200 [3]四川大学华西医院重症医学科,四川成都610041

出　　处：《西部医学》2017年第8期1137-1140,共4页Medical Journal of West China

基　　金：四川省科技计划支撑项目(2015SZ0234-6)

摘　　要：目的探讨彩色多普勒超声检测ICU肝性脑病患者门静脉血流动力学的临床价值。方法纳入79例ICU肝性脑病患者(West-Haven分级3~4级),其中急性肝功能衰竭15例,严重肝硬化64例,采用彩色多普勒超声检测患者门静脉血流动力学的相关指标:门体压力梯度、门静脉直径(PVD)、流速(PVV)和血流量(PVF)以及脾静脉内径(SVD)、血流速度(SVV)和血流量(SVF),同时检测血氨、总胆红素(TBIL)、谷丙转氨酶(ALT)和白蛋白(ALB)并进行谵妄评分。分析门静脉血流动力学改变与临床预后的关系。结果 79例患者中治疗有效组61例(77.2%),无效组18例(22.8%),两组患者性别、年龄、West-Haven分级、基础病因、TIPS术比例及病程比较,差异均无统计学意义(P>0.05)。有效组门体压力梯度、PVD、PVF、SVD和SVF明显低于无效组,而PVV和SVV高于无效组,差异均有统计学意义(P<0.05)。两组血氨、TBIL、ALT和ALB水平比较,差异均无统计学意义(P>0.05)。有效组的谵妄评分低于无效组,差异有统计学意义(P<0.05)。结论超声检测肝性脑病患者门静脉血流动力学改变较常规肝脏生化指标检测对疗效评估可能更具有临床价值。Objective To study the clinical value of portal vein hemodynamics by color Doppler ultrasound for hepatic en- cephalopathy patients in ICU. Methods 79 hepatic encephalopathy patients in ICU of West-Haven class 3-4 were enrolled in- cluding 15 cases of acute liver failure, other 64 cases of severe cirrhosis. The pressure gradient of portal-systemic vein, portal vein diameter （PVD）, portal vein velocity （PVV）, portal vein flow （PVF）, splenic vein diameter （SVD）, splenic vein velocity （SW） and splenic vein flow （SVF） were detected by color Doppler ultrasound The levels of blood ammonia, total bilirubin （TBIL）, glutamic pyruvic transaminase （ALT） and albumin （ALB） and the delirium scores were measured and analyzed. Results 61 cases （77.2%） was effective （effective group） and 18 cases （22.8%） was not effective （non-effective group）. The gender, age, West-Haven classes, etiologies, TIPS proportion and disease course of patients in effective group and non-effective group were no statistical different （P〈0. 05）. The pressure gradient of portal-systemic vein, PVD, PVF, SVD and SVF in effective group were significantly lower than that in non-effective group （P〈0. 05）. PVV and SVV in effective group were significantly higher than that in non-effective group （P〈0. 05）. The levels of blood ammonia, TBIL, ALT and ALB in the two groups were no statistical differences （P〉0. 05）. The delirium scores in the effective group was lower than that in the non-effective group. Conclusion It is more valuable of portal vein hemodynamics changes by color Doppler ultrasound than common liver biochemical indicators for clinical prognosis in hepatic encephalopathy patients.

关 键 词：彩色多普勒超声 ICU 肝性脑病 门静脉血流动力学 

分 类 号：R445.1[医药卫生—影像医学与核医学]