硝苯地平控释片对肝硬化患者门脉血流动力学影响的双功多普勒观察.doc

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1、硝苯地平控释片对肝硬化患者门脉血流动力学影响的双功多普勒观察硝苯地平控释片对肝硬化患者门脉血流动力学影响的双功多普勒观察秦成勇刘东兴朱菊人傅丽娜万昭海张国全贾涛【摘要】目的研究硝苯地平控释片对门脉高压的治疗作用。方法以双功多普勒技术检测了32例肝硬化门脉高压患者在用硝苯地平控释片30mg1Wd前后门脉血流动力学的变化。结果用药后门静脉流速降低，充血指数上升；脾静脉流速、流量降低；肝动脉、脾动脉的阻力指数及脉动指数降低；肝总血流量增加；平均动脉压及心率无显著变化。结论肝、脾动脉的阻力指数及搏动指数是门脉阻力的良好指标

2、。硝苯地平控释片可通过如下机制降低门脉压：①降低全身血压引起交感神经反射使内脏动脉收缩，门脉血流减少；②扩张门脉及肝窦，降低门脉阻力；③扩张侧支循环。该药对血压正常的肝硬化患者的平均动脉压无显著影响，有良好的应用前景。【关键词】双功多普勒；硝苯地平控释片；门脉血流动力学；阻力扌旨数；脉动扌旨数Effectsofrelease-controllednifedipineonportalhemodynamicsincirrhoticpatientsevaluatedbyduplexDopplerultrasonograp

3、hyQINChengyong,LIUDongxing,ZHUJuren,etal.(DepartmentofDigestiveMedicine,ShandongProvincialHospital,Jinan250021,China)[Abstract]ObjectiveToevaluatethetherapeuticeffectofrelease-controllednifedipineonportalhypertension.Methods32cirrhoticpatientswereenrolledtoinv

4、estigatetheportalhemodynamicchangesbeforeandaftergivenAdalatGITS30mgqdbyduplexdopplerultrasonography.ResultsAftergiventhetherapy,thediameter(D)、bloodvelocity(V)andbloodflow(Q)ofportalveindecreased,however,onlythechangeofVhadstatisticalsign讦icance.Thecongestion

5、index(Cl)increased;theVandQofsplenicveinsigrdficantlydecreased;theresistanceindex(Rl)andpulsationindex(PI)ofrighthepaticartery(RHA)andsplenicarterydecreasedobviously.TotalhepaticbloodflowwaselevatedslightlyandtherewerenosignificantchangesinMAPandHR.Conclusions

6、RlandPIofhepaticarteryandsplenicartreyaregoodindicesofportalresistanee,release-controllednifedipinemaydecreaseportalpressurebythefollowingmechanisms:①decreaseofsystemicbloodpressuretriggersthesympatheticreflex,leadingtosplanchnicarteryconstrictionportalbloodfl

7、owreduction.②dilatationoftheportalveinandsinusoidstodecreasetheportalresistanee.③dilatationofthecollateralveins.Thisdrughasnoobviouseffectonthesystemiccirculationinnormotensivecirrhoticpatients,hence,ithasagoodprospectforclinicaluseinportalhypertension.【Keywor

8、ds]DuplexDopplerultrasonography;Release-controllednifedipine;Hemodynamics,portal;Resistaneeindex;Pulsationindex当前对门脉高压的控制尚缺乏理想的药物。硝苯地平控释片具冇稳定的血药浓度及较好的血流动力学效应，本文采用双功多普勒技术检测该药对门脉系统血流