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[肝部分切除术后全身血流动力学的临床研究,特别关注肝硬化患者]

[The clinical study of systemic hemodynamics after partial hepatectomy, with special reference to cirrhotic subjects].

作者信息

Harada A

出版信息

Nihon Geka Gakkai Zasshi. 1985 Jan;86(1):62-72.

PMID:3974568
Abstract

To elucidate the pathophysiological role of partial hepatectomy on systemic hemodynamics, general hemodynamics were investigated in 29 patients pre and postoperatively. Twenty-five patients with smooth postoperative course were divided into two groups, non-cirrhotic (n = 15) and cirrhotic (n = 10). On the first postoperative day (p.o.d.), cardiac index (CI) increased significantly but arteriovenous oxygen content difference (C(a-v)O2) didn't increase in non-cirrhotics. While, increased in cirrhotics, CI increased only mildly and C(a-v)O2 increased. In both groups oxygen consumption (VO2) increased significantly. Since these characteristic pattern in cirrhotics were even clearer in patients with lower functional reserve of remnant liver, it was suggested that cardiac function was suppressed under decreased functional reserve of remnant liver. Four cirrhotics fell into hepatic failure during early postoperative period. On the first p.o.d., CI and C(a-v)O2 of these patients didn't increased, and VO2 decreased slightly. On the second p.o.d., CI increased but C(a-v)O2 and VO2 decreased extremely. It seemed likely that these disturbance of oxygen uptake and consumption affected function of remnant liver considerably.

摘要

为阐明部分肝切除术对全身血流动力学的病理生理作用,对29例患者术前和术后的一般血流动力学进行了研究。25例术后病程顺利的患者被分为两组,非肝硬化组(n = 15)和肝硬化组(n = 10)。在术后第一天(p.o.d.),非肝硬化患者的心指数(CI)显著增加,但动静脉氧含量差(C(a-v)O2)未增加。而在肝硬化患者中,CI仅轻度增加,C(a-v)O2增加。两组的氧耗量(VO2)均显著增加。由于在残余肝功能储备较低的患者中,肝硬化患者的这些特征性模式更为明显,提示残余肝功能储备降低时心脏功能受到抑制。4例肝硬化患者在术后早期发生肝衰竭。在术后第一天,这些患者的CI和C(a-v)O2未增加,VO2略有下降。在术后第二天,CI增加,但C(a-v)O2和VO2极度下降。氧摄取和消耗的这些紊乱似乎对残余肝的功能有相当大的影响。

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