肝硬化门静脉高压血流动力学紊乱发生及发展机制  

Occurrence and progression of hemodynamic dysfunction in cirrhotic portal hypertension

作　　者：黄登 曹君贵 叶航羊 王云 郑建伟[1] Huang Deng;Cao Jungui;Ye Hangyang;Wang Yun;Zheng Jianwei(Department of Hepatobiliary,General Hospital of Tibet Military Command Area,Lhasa 850007,China)

机构地区：[1]中国人民解放军西藏军区总医院肝胆科,拉萨850007

出　　处：《中华消化外科杂志》2021年第10期1117-1122,共6页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82103651)。

摘　　要：肝硬化门静脉高压是指慢性肝损伤致肝窦结构和功能异常,阻碍门-体血液回流,导致以门静脉系统压力逐渐升高为临床表现的系列综合征。肝内血流阻力增加和门静脉系统血流量增大是肝硬化门静脉高压发生的主要原因。肝窦结构和功能异常不仅引起血流阻力增加,还导致肝窦血液与肝细胞之间的物质交换障碍,从而诱发内脏动脉扩张,门静脉系统血流量增大,进而推动门静脉系统压力持续升高。内脏动脉血流动力学紊乱是诱发病人出现高动力循环的重要因素。随着疾病进展,门静脉高压可不断促进高动力循环活跃,高动力循环反之又可促进门静脉高压进展,形成恶性循环,是终末期肝病难以逆转、不可治疗的主要原因。笔者对肝硬化门静脉高压、内脏血流动力学紊乱和高动力循环形成的病理、生理机制进行文献综述。Cirrhotic portal hypertension refers to a series of syndroms characterized by structural abnormality and dysfunction of hepatic sinusoid caused by chronic liver injury and obstructing portal-systemic blood flow,resulting in gradually increased portal venous system pressure as clinical manifestations.Increased intrahepatic resistance and portal venous system blood flow are main causes for cirrhotic portal hypertension.The structural abnormality and dysfunction of hepatic sinusoid cause not only increased intrahepatic resistance,but also substance exchange barriers between hepatic sinusoidal blood and hepatocytes,resulting in splanchnic artery dilation and increased blood flow and pressure of portal venous system.Dysfunction of splanchnic hemodynamic is an important factor for hyperdynamic circulation in cirrhotic portal hypertension.As the disease progresses,cirrhotic portal hypertension can continuously promote the activation of hyperdynamic circulation,which in turn can accelerate the development of cirrhotic portal hyperten-sion.This vicious circle is the main reason for the irreversible and untreatable end-stage liver disease.The authors review the pathophysiological mechanisms of cirrhotic portal hypertension,splanchnic hemodynamic dysfunction and hyperdynamic circulation.

关 键 词：肝硬化 门静脉高压 肝血窦 血流动力学 高动力循环 

分 类 号：R575.2[医药卫生—消化系统]