门静脉血流峰 - 峰值搏动百分比可预测右侧充血性心力衰竭。
Percentage of peak-to-peak pulsatility of portal blood flow can predict right-sided congestive heart failure.
作者信息
Hu Jui-Ting, Yang Sien-Sing, Lai Yun-Chih, Shih Cheng-Yen, Chang Cheng-Wen
机构信息
Liver Unit, Cathay General Hospital, Taipei, Taiwan.
出版信息
World J Gastroenterol. 2003 Aug;9(8):1828-31. doi: 10.3748/wjg.v9.i8.1828.
AIM
To study the change of portal blood flow for the prediction of the status of right-sided heart failure by using non-invasive way.
METHODS
We studied 20 patients with rheumatic and atherosclerotic heart diseases. All the patients had constant systemic blood pressure and body weight 1 week prior to the study. Cardiac index (CI), left ventricular end-diastolic pressure (LVEDP), mean aortic pressure (AOP), pulmonary wedge pressure (PWP), mean pulmonary arterial pressure (PAP), mean right atrial pressure (RAP), right ventricular end-diastolic pressure (RVEDP) were recorded during cardiac catheterization. Ten patients with RAP >10 mmHg were classified as Group 1. The remaining 10 patients with RAP >=10 mmHg were classified as Group 2. Portal blood velocity profiles were studied using an ultrasonic Doppler within 12 h after cardiac catheterization.
RESULTS
CI, AOP, and LVEDP had no difference between two groups. Patients in Group 1 had normal PWP (14.6+/-7.3 mmHg), PAP (25.0+/-8.2 mmHg), RAP (4.7+/-2.4 mmHg), and RVEDP (6.4+/-2.7 mmHg). Patients in Group 2 had increased PWP (29.9+/-9.3 mmHg), PAP (46.3+/-13.2 mmHg), RAP (17.5+/-5.7 mmHg), and RVEDP (18.3+/-5.6 mmHg) (P<0.001). Mean values of maximum portal blood velocity (Vmax), mean portal blood velocity (Vmean), cross-sectional area (Area) and portal blood flow volume (PBF) had no difference between 2 groups. All the patients in Group 1 had a continuous antegrade portal flow with a mean percentage of peak-to-peak pulsatility (PP) 27.0+/-8.9 % (range: 17-40 %). All the patients in Group 2 had pulsatile portal flow with a mean PP 86.6+/-45.6 (range: 43-194 %). One patient had a transient stagnant and three patients had a transient hepatofugal portal flow, which occurred mainly during the ventricular systole. Vmax, Vmean and PBF had a positive correlation with CO (P<0.001) but not with AOP, LVEDP, PWP, PAP, RAP, and RVEDP. PP showed a good correlation (P<0.001) with PWP, PAP, RAP, and RVEDP but not with CI, AOP, and LVEDP. All the patients with PP >40 % had a right-sided heart failure with a RAP=10 mmHg.
CONCLUSION
The measurement of PP change is a simple and non-invasive way to identify patients with right heart failure.
目的
采用非侵入性方法研究门静脉血流变化以预测右心衰竭状态。
方法
我们研究了20例风湿性和动脉粥样硬化性心脏病患者。所有患者在研究前1周血压和体重恒定。在心脏导管插入术期间记录心脏指数（CI）、左心室舒张末期压力（LVEDP）、平均主动脉压（AOP）、肺楔压（PWP）、平均肺动脉压（PAP）、平均右心房压（RAP）、右心室舒张末期压力（RVEDP）。10例RAP>10 mmHg的患者被分为第1组。其余10例RAP≥10 mmHg的患者被分为第2组。在心脏导管插入术后12小时内使用超声多普勒研究门静脉血流速度剖面。
结果
两组间CI、AOP和LVEDP无差异。第1组患者的PWP（14.6±7.3 mmHg）、PAP（25.0±8.2 mmHg）、RAP（4.7±2.4 mmHg）和RVEDP（6.4±2.7 mmHg）正常。第2组患者的PWP（29.9±9.3 mmHg）、PAP（46.3±13.2 mmHg）、RAP（17.5±5.7 mmHg）和RVEDP（18.3±5.6 mmHg）升高（P<0.001）。最大门静脉血流速度（Vmax）、平均门静脉血流速度（Vmean）、横截面积（Area）和门静脉血流量（PBF）的平均值在两组间无差异。第1组所有患者门静脉血流呈连续顺行，峰-峰搏动性（PP）平均百分比为27.0±8.9%（范围：17 - 40%）。第2组所有患者门静脉血流呈搏动性，平均PP为86.6±45.6（范围：43 - 194%）。1例患者出现短暂血流停滞，3例患者出现短暂门静脉逆流，主要发生在心室收缩期。Vmax、Vmean和PBF与心输出量（CO）呈正相关（P<0.001），但与AOP、LVEDP、PWP、PAP、RAP和RVEDP无关。PP与PWP、PAP、RAP和RVEDP呈良好相关性（P<0.001），但与CI、AOP和LVEDP无关。所有PP>40%的患者均有右心衰竭且RAP = 高10 mmHg。
结论
测量PP变化是识别右心衰竭患者的一种简单且非侵入性的方法。
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