高压氧治疗对肝硬化门脉高压症患者疗效及血流动力学的影响  

Efficacy of hyperbaric oxygen therapy on patients with cirrhosis and portal hypertension and its effects on hemodynamic indexes

作　　者：韩丰 王霄腾 章燕红 Han Feng;Wang Xiaoteng;Zhang Yanhong(Zhejiang Chinese Medical University,Hangzhou,310053,China;Department of Gastroenterology,The First Hospital of Jiaxing,Jiaxing,314000,China)

机构地区：[1]浙江中医药大学,杭州310053 [2]嘉兴市第一医院消化内科,嘉兴314000

出　　处：《中华航海医学与高气压医学杂志》2023年第1期47-52,共6页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

基　　金：嘉兴市科技计划项目(2019AD32260)。

摘　　要：目的探索高压氧治疗对肝硬化门脉高压症患者疗效及血流动力学的影响。方法选取2021年1月至2022年3月嘉兴市第一医院收治的肝硬化门脉高压症患者68例,按随机数字表法分为对照组(n=34)与观察组(n=34)。2组患者均采取内科常规治疗,观察组增加高压氧治疗。对2组患者治疗前后的血流动力学参数、血管活性物质水平、肝功能指标、肝纤维化指标、血常规、脾脏缩小情况及食管胃底静脉曲张缓解情况进行比较,并记录并发症的发生情况。结果(1)治疗后观察组患者的门静脉内径(DPV)、门静脉最大血流速度(PVX)、门静脉血流量(PVF)、脾静脉内径(DSV)、脾静脉最大血流速度(SPVX)、脾静脉血流量(SVF)均较对照组下降,差异均有统计学意义(均P<0.05);(2)治疗后观察组患者的内皮素1(ET-1)、一氧化氮(NO)、胰高血糖素(GLU)水平较对照组均下降,差异有统计学意义(均P<0.05);(3)治疗后观察组患者的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)及总胆红素(TBIL)水平均较对照组下降,差异均有统计学意义(均P<0.05);(4)治疗后观察组患者的透明质酸(HA)、层粘连蛋白(LN)、Ⅲ型前胶原(PCⅢ)及Ⅳ型胶原(Ⅳ-C)指标均较对照组下降,差异均有统计学意义(均P<0.05);(5)治疗后观察组患者的白细胞、血小板、红细胞、血红蛋白水平均较对照组明显好转,脾脏缩小情况及食管胃底静脉曲张缓解情况均优于对照组,差异均有统计学意义(均P<0.05)。(6)2组患者在治疗期间均未出现食管胃底静脉曲张破裂出血或其他严重并发症。结论对肝硬化门脉高压症患者采取高压氧治疗,能有效改善血流动力学指标及血管活性物质水平,有助于肝功能恢复,减轻肝纤维化水平,临床上值得推广。Objective To analyze the efficacy of hyperbaric oxygen therapy on the patients with cirrhosis and portal hypertension and its effects on the hemodynamic indexes.Methods Sixty-eight patients with cirrhosis and portal hypertension treated in The First Hospital of Jiaxing from January 2021 to March 2022 were randomly divided into control group(n=34)and observation group(n=34).Both groups were given conventional medical treatment,the observation group was additionally given hyperbaric oxygen therapy.The hemodynamic indexes,vasoactive substance levels,liver function indexes,and liver fibrosis indexes were observed.Results(1)After treatment,DPV,PVX,PVF,DSV,SPVX,and SVF in the observation group decreased significantly compared with those in the control group(P<0.05);(2)After treatment,the levels of ET-1,NO,and GLU in the observation group were significantly better than those in the control group(P<0.05);(3)After treatment,the levels of ALT,AST,and TBIL in the observation group were significantly better than those in the control group(P<0.05);(4)After treatment,HA,LN,PCⅢ,and IV-C in the observation group decreased significantly(P<0.05);(5)After treatment,the levels of complete blood count in the observation group were significantly improved,and the spleen shrinkage and the relief of esophageal and gastric varices in the observation group were better than those in the control group,with statistically significant differences(P<0.05).(6)During treatment,both groups had no occurrence of esophagogastric variceal hemorrhage or other severe complications.Conclusion Hyperbaric oxygen therapy for patients with cirrhosis and portal hypertension can effectively improve hemodynamic indexes and vasoactive substance levels,contribute to the recovery of liver function,and reduce the severity of liver fibrosis.The therapy,therefore,is worth application in clinical practice.

关 键 词：高压氧 肝硬化 门脉高压 血流动力学 

分 类 号：R575.2[医药卫生—消化系统]