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静脉导管的血流动力学

Hemodynamics of the ductus venosus.

作者信息

Kiserud T

机构信息

Department of Obstetrics and Gynecology, Bergen University Hospital, Norway.

出版信息

Eur J Obstet Gynecol Reprod Biol. 1999 Jun;84(2):139-47. doi: 10.1016/s0301-2115(98)00323-6.

Abstract

Although the ductus venosus has a similar function in human as in animal pregnancies (to regulate the shunting of oxygenated blood from the umbilical vein towards the left atrium), the amount of blood shunted in the human fetus seems to be less (25-40%) than in the animal (50%). The degree of shunting depends both on the resistance of the portal vasculature in the liver as well as the resistance of the ductus venosus itself. Neural and endocrine regulation plays a role in this distribution, as do fluid mechanical forces; blood viscosity and umbilical venous pressure are powerful determinants. There is a high degree of shunting at reduced umbilical venous pressure, and by increasing hematocrit, and viscosity, the distribution shifts from the liver to the ductus venosus. Additionally, the ductus venosus acts as transmission line in the opposite direction for the atrial pressure waves. Shape, viscosity, compliance, and particularly the diameter of the inlet are suggested to influence the pulsatility of the blood velocity at the ductus venosus inlet--and determine the degree of wave transmission into the umbilical vein. Occurrence of umbilical venous pulsation, an important diagnostic sign, is also dependent upon the size and compliance of the umbilical vein.

摘要

尽管静脉导管在人类和动物孕期具有相似功能(将含氧血从脐静脉分流至左心房),但人类胎儿的分流血量似乎比动物少(25%-40%,动物为50%)。分流量取决于肝脏门静脉系统的阻力以及静脉导管本身的阻力。神经和内分泌调节以及流体机械力在此分布中发挥作用;血液粘度和脐静脉压力是重要决定因素。脐静脉压力降低时会出现高度分流,通过提高血细胞比容和粘度,血液分布会从肝脏转向静脉导管。此外,静脉导管还作为心房压力波相反方向的传输线。有人认为,形状、粘度以及顺应性,尤其是静脉导管入口直径,会影响静脉导管入口处血流速度的搏动性,并决定压力波传入脐静脉的程度。重要诊断体征——脐静脉搏动的出现也取决于脐静脉的大小和顺应性。

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