Department of Clinical Physiology and Nuclear Medicine, Centre of Functional Imaging and Research, Hvidovre Hospital, Copenhagen, Denmark.
Eur J Gastroenterol Hepatol. 2013 May;25(5):523-30. doi: 10.1097/MEG.0b013e32835d09fe.
Refractory ascites and recurrent variceal bleeding are among the serious complications of portal hypertension and cirrhosis for which a transjugular intrahepatic portosystemic shunt (TIPS) can be used. Cirrhotic patients have varying degrees of haemodynamic derangement, mainly characterized by peripheral arterial vasodilatation, central underfilling and activation of several vasoactive systems. These changes affect the heart, the lungs and the kidneys in particular. The cardiac effects of TIPS are immediate and are related to the redirection of blood from the splanchnic circulation into the systemic circulation, resulting in worsening of the hyperdynamic circulation with increasing cardiac output and decreasing systemic vascular resistance; further, TIPS may unmask a latent diastolic dysfunction of the heart. However, the renal effects of TIPS seem to be beneficial as renal function tends to improve in patients with the hepatorenal syndrome. The clinical and haemodynamic effects of TIPS have been studied intensively and will be reviewed in the present paper. Considerable knowledge on the effects of TIPS on the pathophysiology of cirrhosis has been gained, but studies on the central haemodynamic effects are warranted to refine the already applied treatments and develop new treatment modalities.
难治性腹水和复发性静脉曲张出血是门静脉高压和肝硬化的严重并发症之一，可采用经颈静脉肝内门体分流术（TIPS）治疗。肝硬化患者存在不同程度的血流动力学紊乱，主要表现为外周动脉血管扩张、中心血容量不足和多种血管活性系统的激活。这些变化尤其会影响心脏、肺部和肾脏。TIPS 的心脏效应是即刻发生的，与血液从内脏循环重新分配到体循环有关，导致心输出量增加和全身血管阻力降低，从而加重高动力循环；此外，TIPS 可能会揭示心脏潜在的舒张功能障碍。然而，TIPS 的肾脏效应似乎是有益的，因为肝肾综合征患者的肾功能往往会改善。TIPS 的临床和血流动力学效应已经得到了深入研究，本文将对此进行综述。人们已经获得了相当多关于 TIPS 对肝硬化病理生理学影响的知识，但仍需要研究 TIPS 对中心血流动力学的影响，以完善已有的治疗方法并开发新的治疗方法。
