双剂量奥曲肽对肝硬化门脉高压症断流术后患者血流动力学的影响双

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1、维普资讯http://www.cqvip.com·29O·2007年4月第46卷第4期ChinJInternMed，Apri!，，：．论著．双剂量奥曲肽对肝硬化门脉高压症断流术后患者血流动力学的影响卢实春孟繁坤丁惠国张劲光丁蕾王淑珍【摘要】目的研究双剂量奥曲肽对肝硬化门脉高压症断流术后患者门脉压力、肝脏血流动力学影响。方法肝硬化门脉高压症断流术患者26例，随机分两组，术后24h开始用奥曲肽。A组12例，奥曲肽50g／h；B组14例，奥曲肽25g／h；胃网膜右静脉插管至门静脉主干，动态测定门脉压力；彩色超声多普勒测定门脉直径(PV)、门脉最大血流速度(PFV～

2、)、门脉平均血流速度(PFV一)、肝动脉最大血流速度(HAV～)、肝动脉最小血流速度(HAVⅢi)；计算门脉血流量参数(PFI)、肝动脉血流量参数(HAFI)。结果断流术后，两组患者门脉压力平均降幅15．4％，PFI降低(P<0．05)；HAV～、HAVⅢiHAFI增加(P<0．05)。用奥曲肽72h后，两组PFI、PFV～、PFV一降低(P<0．05)；用药5rain门脉压力降低，24h达高峰，门脉压力平均降幅20．6％。A组停药后48h内，门脉压力未见回升，平均降幅23．1％；B组停药后2h门脉压力有回升趋势，平均降幅11．6％；停药后24h、48h两组

3、患者门脉压力比较差异有统计学意义(P<0．01)。Logistic分析发现，PV、PFV～、PFV一、HAV～、HAV与门脉压力无独立相关性。结论肝硬化门脉高压症患者行断流术后，门脉压力降低。双剂量奥曲肽均能明显降低门脉压力；停药后48h内，奥曲肽50g／h组门脉压力未见回升。提示，临床用奥曲肽50oe／h对防止静脉曲张再出血更合理。【关键词】高血压，门静脉；肝硬化；血流动力学；奥曲肽Efectsoftwodifferentdosagesofoctreotideonportalpressureandhepatichemodynamicsincirrhotic

4、portalhypertensivepatients8fgerportal-azygousdevascularizafionandsplenectomyU·chun‘，MENGFan-kun，DINGHui-guo，ZHANGJin-guang，DINGLei，4ⅣGShu-zhen．‘DepartmentofSurgery，BengYout帆Hospital，beingAfiliatedtoCapitalMedicalUnwersity，B啕tng100069．ChinaLUshi．chun．MENGFan-kun．DINGHt．guocontribute

5、dequallytothisstudyCorrespondingauthor：DINGHui．guo．Email：dinghuiguo@medmail．corn．cn【Abstract】ObjectiveIncreasedportalinflowandintrahepaticresistancemayplayapartoftheroleinpathogenesisofportalhypertensionincirrhoticpatients．Somevasoactivesubstancesmayplayanimportantroleintheregulati

6、onofhepatichemodynamics．刀leaimofthisstudyistoinvestigatetheefectsoftwodiferentdosagesofoctreotideonportalpressureandhepatichemodynamics．Methods26cirhoticpatientswhounderwentportal-azygousdevascularizationandsplenectomywereinvestigatedinarandomizedanddouble-blindstudy．Patientswereas

7、signedtoreceivetreatmenteitherwit}Iabolusofoctreotide100I~g．foHowedbyinfusionof50昏／hfor72h(GroupA，n=12)orwithabolusofoctreotide100I．Lg，foHowedbyinfusionof25s／hfor72h(GroupB，n=14)．Theportalpressurewasdynamicalymeasuredviaacatheterplacedinportalvein．Theindexesofhepatichemodynamics．in

8、cludingmaximalandmeanveloc