Gibson P R, Gibson R N, Donlan J D, Jones P A, Colman J C, Dudley F J
University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Victoria, Australia.
J Gastroenterol Hepatol. 1996 Jan;11(1):14-20. doi: 10.1111/j.1440-1746.1996.tb00004.x.
The validity and clinical relevance of Doppler flowmetry in measuring changes in regional blood flow are uncertain. In the present study we compared changes induced ketanserin in regional splanchnic blood flow as measured by Doppler flowmetry with changes in conventionally measured systemic and in hepatic haemodynamic indices estimated pharmacokinetically using indocyanine green. Fourteen patients with alcoholic cirrhosis and portal hypertension were evaluated. On multivariate analyses, significant associations were noted for only three indices: changes in estimated hepatic blood flow were predicted jointly by changes in flow in the main and right portal veins and hepatic artery (R2 = 0.80); changes in intrahepatic shunting (indocyanine green extraction) were predicted by changes in flow in the main and right portal veins (R2 = 0.55); and changes in sinusoidal perfusion (indocyanine green clearance) were significantly predicted by changes in main portal vein flow alone (R2 = 0.76). These data support the validity of Doppler flowmetry in quantifying change in regional blood flow, but highlight the limitations in its clinical application and interpretation. The association of changes in main portal vein flow with changes in sinusoidal perfusion has clinical potential but requires confirmation using other modulating drugs.
多普勒血流仪在测量局部血流变化方面的有效性和临床相关性尚不确定。在本研究中，我们将通过多普勒血流仪测量的酮色林诱导的内脏局部血流变化与通过传统方法测量的全身血流变化以及使用吲哚菁绿通过药代动力学估算的肝脏血流动力学指标变化进行了比较。对14例酒精性肝硬化和门静脉高压患者进行了评估。在多变量分析中，仅发现三个指标存在显著关联：估计肝血流量的变化由门静脉主干、右门静脉和肝动脉血流变化共同预测（R2 = 0.80）；肝内分流（吲哚菁绿摄取）的变化由门静脉主干和右门静脉血流变化预测（R2 = 0.55）；仅门静脉主干血流变化就显著预测了肝窦灌注（吲哚菁绿清除率）的变化（R2 = 0.76）。这些数据支持了多普勒血流仪在量化局部血流变化方面的有效性，但突出了其在临床应用和解释方面的局限性。门静脉主干血流变化与肝窦灌注变化之间的关联具有临床潜力，但需要使用其他调节药物进行证实。
