彩色多普勒超声在评估经颈静脉肝内门体分流术后凝血功能障碍中的价值研究  

The value of color doppler ultrasound on the survey of patients’ coagulopathy who have experienced the procedure of transjugular intrahepatic portosystemic shunt

作　　者：刘爱莲[1] 宋璞 陈立光[2] 宋璇 范凤景 李菲 丁红宇[1] LIU Ailian;SONG Pu;CHEN Liguang;SONG Xuan;FAN Fengjing;LI Fei;DING Hongyu(Department of Ultrasound, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated With Shandong First Medical University, Jinan 250014, P.R.China;Shandong Medical Imaging Research Institute, Affiliated to Shandong University, Jinan 250021, P.R.China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)超声诊疗科,山东济南250014 [2]山东大学附属山东省医学影像学研究所,山东济南250021

出　　处：《医学影像学杂志》2019年第8期1358-1362,共5页Journal of Medical Imaging

摘　　要：目的 探讨应用彩色多普勒超声测量门静脉灌注量在评估门静脉高压患者经颈静脉肝内门体分流术(TIPS)后凝血功能障碍中的价值。方法 收集111例接受TIPS且在术后应用彩色多普勒超声测量门静脉灌注量,应用SPSS20.0统计软件进行统计分析,采用卡方检验,判断性别、年龄、术前门静脉灌注量、术后门静脉灌注量等与TIPS术后凝血功能障碍的相关性,筛选出相关因素,然后采用二分类logistic回归分析方法,得出患者TIPS术后发生凝血功能障碍的影响因素,进而判断彩色多普勒超声检测门静脉灌注量在评估TIPS术后凝血功能障碍中是否有应用价值。结果 111例行TIPS患者中,82例(73.9%)发生术后肝脏凝血功能障碍。卡方检验表明既往出血次数、术前凝血功能障碍、术前血清前白蛋白、术前门静脉灌注量、分流的门静脉选择、术后门静脉灌注量与TIPS术后凝血功能障碍有关。经二分类logistic回归分析,得出TIPS术后发生凝血功能障碍概率(P)的方程:p=exp(9.541-0.007a-0.30b)/1+exp(9.541-0.007a-0.30b),公式中a为术后门静脉灌注量,b为术前血清前白蛋白。结论 TIPS术后门静脉灌注量是术后凝血功能障碍的保护因素,TIPS术后应用彩色多普勒超声测量门静脉灌注量在评估术后凝血功能障碍中有重要价值。Objective To study the value of measuring hepatic portal perfusion by using color doppler ultrasound on the survey of patient's coagulopathy who have experienced the procedure of transjugular intrahepatic portosystemic shunt. Methods 111 patients receiving TIPS and using color Doppler ultrasound to measure portal vein perfusion after TIPS were collected. SPSS 20.0 statistical software was used for statistical analysis. Chi-square test was used to determine the correlation between gender, age, preoperative portal vein perfusion, postoperative portal vein perfusion and coagulation dysfunction after TIPS. Relevant factors were screened out, and then binary logistic regression was used. By regression analysis, the influencing factors of coagulation dysfunction after TIPS were obtained, and then the value of color Doppler ultrasound in evaluating coagulation dysfunction after TIPS was judged. Results Eighty-two cases presented coagulopathy, accounting for 73.9%. Chi-square test showed that the coagulopathy of who have experienced TIPS related to pervious episodes of bleeding, the selection of potal vein during the TIPS procedure, the coagulopathy before the TIPS procedure, serum concentrations of prealbumin, distribution of the portal vein and portal vein flow volume before and after TIPS. Eventually, the equations p=exp (9.541-0.007a-0.30b)/1+exp(9.541-0.007a-0.30b) were calculated by logistic regression model (a,b represenest prealbumin and portal vein flow volume after TIPS respectively). Conclusion The hepatic portal perfusion is the protective factor of coagulopathy of patients who have experienced TIPS. Color doppler ultrasounds, which measures hepatic portal perfusion, plays an important role in the survey of patients coagulopathy who have experienced TIPS.

关 键 词：彩色多普勒超声 经颈静脉肝内门体分流术 凝血功能 

分 类 号：R575.1[医药卫生—消化系统] R445.1[医药卫生—内科学]