Vorobioff J, Bredfeldt J E, Groszmann R J
Gastroenterology. 1984 Nov;87(5):1120-6.
Portal venous pressure is the result of the interplay between portal venous blood flow and the vascular resistance offered to that flow. Whether portal hypertension is maintained only by an increased portal venous resistance or also by an increased blood flow within the portal venous system is still open to speculation. To resolve these differences, splanchnic and systemic hemodynamics were evaluated in cirrhotic rats, induced by CCl4. Blood flow and portal-systemic shunting were measured by radioactive microsphere techniques. All cirrhotic rats had portal hypertension (portal venous pressure 13.5 +/- 1.1 vs. 9.0 +/- 0.5 mmHg, in normal control rats; p less than 0.01), but portal-systemic shunting in cirrhosis (31% +/- 13% vs. 0.2% +/- 0.02%; p less than 0.05) was variable, ranging from 1% to 97%. Portal venous inflow, the total blood flow within the portal system, was increased in cirrhotic rats (5.75 +/- 0.04 vs. 4.52 +/- 0.36 ml/min per 100 g; p less than 0.05). Total splanchnic arterial resistance was reduced in cirrhotic rats (3.3 +/- 0.2 vs. 5.8 +/- 0.5 dyn X s X cm-5 X 10(5); p less than 0.01). Portal venous resistance, however, was not abnormally elevated in cirrhotic rats (4.6 +/- 0.5 vs. 4.7 +/- 0.5 dyn X s X cm-5 X 10(4), p = NS). Splanchnic hemodynamics in cirrhotic rats demonstrate that portal hypertension is maintained, at least in part, by a hyperdynamic portal venous inflow. The hemodynamic data in cirrhotic rats provided evidence that supports the role of an increased portal blood flow in portal hypertension and gives a quantitative definition of splanchnic hemodynamics in intrahepatic portal hypertension.
门静脉压力是门静脉血流与该血流所遇到的血管阻力之间相互作用的结果。门静脉高压仅仅是由门静脉阻力增加维持,还是也由门静脉系统内血流量增加维持,仍有待推测。为了解决这些分歧,对由四氯化碳诱导的肝硬化大鼠的内脏和全身血流动力学进行了评估。采用放射性微球技术测量血流量和门体分流。所有肝硬化大鼠均有门静脉高压(门静脉压力:正常对照大鼠为9.0±0.5 mmHg,肝硬化大鼠为13.5±1.1 mmHg;p<0.01),但肝硬化时的门体分流(31%±13% vs. 0.2%±0.02%;p<0.05)各不相同,范围为1%至97%。肝硬化大鼠的门静脉流入量,即门静脉系统内的总血流量增加(每100 g为5.75±0.04 vs. 4.52±0.36 ml/min;p<0.05)。肝硬化大鼠的总内脏动脉阻力降低(3.3±0.2 vs. 5.8±0.5 dyn X s X cm-5 X 10(5);p<0.01)。然而,肝硬化大鼠的门静脉阻力并未异常升高(4.6±0.5 vs. 4.7±0.5 dyn X s X cm-5 X 10(4),p=无显著性差异)。肝硬化大鼠的内脏血流动力学表明,门静脉高压至少部分是由高动力性门静脉流入维持的。肝硬化大鼠的血流动力学数据提供了证据,支持门静脉血流量增加在门静脉高压中的作用,并对肝内门静脉高压时的内脏血流动力学进行了定量定义。