Li Xiao-Qing, Dong Lei, Luo Jin-Yan
Department of Gastroenterology, Second Hospital of Xi'an Jiaotong University, Xi'an 710004, China.
Hepatobiliary Pancreat Dis Int. 2004 Nov;3(4):571-6.
Portal hypertension (PHT) with upper gastrointestinal hemorrhage as its chief complication is a very common disease with great harm to humans. The effects of infusion volume, speed, and type on hemodynamics in case of cirrhosis, PHT esophageal variceal bleeding, and their mechanism should be clarified. This study was designed to assess the effects of different infusion volumes on hemodynamics of PHT canines after hemorrhagic shock (HS).
PHT canine models were made by chronic embolization via coarctating half of the main portal vein with silk suture. Two weeks later, the models were subjected to hemorrhagic shock by quick femoral artery venesection. The canines were divided into two groups to resuscitate: one to receive a large volume of infusion (n=6) (large volume infusion group) and the other to receive a small volume of infusion (n=6) (small volume infusion group). Hemodynamic indexes of PHT canines after HS and infusion were observed closely.
The PHT canines showed a series of hemodynamical changes in hemorrhagic shock stage, which aggravated hemodynamical disorder in PHT. After quick infusion, mean arterial pressure (MAP), inferior vena cava pressure (IVCP), portal venous pressure (PVP), portal vein pressure gradient (PVPG), portal vein blood flow (PVBF), hepatic artery blood flow (HABF) and hepatic blood flow (HBF) increased significantly. These indexes in the large volume infusion group were higher than those in the small volume infusion group. Portal vascular resistance (PVR), splanchnic vascular resistance (SVR), hepatic arterial resistance (HAR) decreased significantly, but PVP, PVPG, PVBF, HABF and HBF showed a rebounding increase above the baseline values in the large volume infusion group. The changes of PVP, PVPG, PVBF, HABF and HBF were in parallel with those of MAP and inferior vena cava pressure (IVCP), without a rebounding increase in the small volume infusion group. In the large volume infusion group PVPG increased earlier and more significantly than did PVP; moreover PVPG exceeded the baseline by 13%, making the possibility of rebleeding great. In the small volume infusion group, PVPG was lower than the baseline by more than 22%, indicating a small possibility of rebleeding. SVR and HAR were lower in the large volume infusion group. PVP, PVPG, PVBF, HABF and HBF were positively correlated with accumulated volume of vein infusion. PVR showed a positive correlation with accumulated volume of vein infusion in the small volume infusion group. HAR was negatively correlated with accumulated volume of vein infusion in the large volume infusion group.
PHT canines after HS, resuscitated by vein infusion, may show a rebounding increase of PVP, PVPG, PVBF, HABF and HBF above the baseline values in the large volume infusion group but not in the small volume infusion group. A large volume infusion causes PVP, PVPG, PVBF, HABF and HBF to increase higher than does a small volume infusion.
以门静脉高压（PHT）并以上消化道出血为主要并发症的疾病极为常见，对人类危害极大。应阐明输注量、速度及类型对肝硬化、PHT食管静脉曲张出血患者血流动力学的影响及其机制。本研究旨在评估不同输注量对失血性休克（HS）后PHT犬血流动力学的影响。
采用丝线结扎门静脉主干一半的方法慢性栓塞制作PHT犬模型。两周后，通过快速股动脉放血使模型发生失血性休克。将犬分为两组进行复苏：一组接受大量输注（n = 6）（大量输注组），另一组接受小量输注（n = 6）（小量输注组）。密切观察HS及输注后PHT犬的血流动力学指标。
PHT犬在失血性休克阶段呈现一系列血流动力学变化，加重了PHT的血流动力学紊乱。快速输注后，平均动脉压（MAP）、下腔静脉压（IVCP）、门静脉压（PVP）、门静脉压力梯度（PVPG）、门静脉血流量（PVBF）、肝动脉血流量（HABF）和肝血流量（HBF）显著升高。大量输注组的这些指标高于小量输注组。门静脉血管阻力（PVR）、内脏血管阻力（SVR）、肝动脉阻力（HAR）显著降低，但大量输注组的PVP、PVPG、PVBF、HABF和HBF在基线值之上出现反跳性升高。小量输注组的PVP、PVPG、PVBF、HABF和HBF变化与MAP和下腔静脉压（IVCP）平行，未出现反跳性升高。大量输注组中PVPG比PVP更早且更显著升高；此外，PVPG超过基线值13%，再出血可能性大。小量输注组中，PVPG低于基线值超过22%，提示再出血可能性小。大量输注组的SVR和HAR较低。PVP、PVPG、PVBF、HABF和HBF与静脉输注累积量呈正相关。小量输注组中PVR与静脉输注累积量呈正相关。大量输注组中HAR与静脉输注累积量呈负相关。
HS后的PHT犬经静脉输注复苏，大量输注组的PVP、PVPG、PVBF、HABF和HBF可能在基线值之上出现反跳性升高，而小量输注组则不会。大量输注导致PVP、PVPG、PVBF、HABF和HBF升高幅度大于小量输注。
