门腔分流对胆管结扎肝硬化大鼠高动力循环的影响。

Effects of portacaval shunting on hyperdynamic circulation in bile duct-ligated cirrhotic rats.

作者信息

Wong J, Zhang Y, Lee S S

机构信息

Liver Unit, University of Calgary, Canada.

出版信息

J Hepatol. 1997 Feb;26(2):369-75. doi: 10.1016/s0168-8278(97)80054-2.

DOI:10.1016/s0168-8278(97)80054-2

PMID:9059959

Abstract

BACKGROUND/AIMS: Liver cirrhosis and portal hypertension are associated with hyperdynamic circulation. Portacaval shunts are widely used to prevent recurrent hemorrhage, but the hemodynamic effects caused by these procedures have not been well characterized in cirrhosis. We therefore compared the hemodynamic effects of both end-to-side and side-to-side portacaval shunts in normal and cirrhotic rats.

METHODS

Sprague-Dawley rats were divided into six groups according to the operations they underwent. End-to-side or side-to-side portacaval shunts were performed in both rats with cirrhosis induced by bile duct ligation and sham-operated rats. Systemic and regional blood flows were measured by the radioactive microsphere method.

RESULTS

Portal pressures in the shunted rats decreased significantly. Cardiac index in cirrhotic rats (557 +/- 27 ml.min-1.kg-1) was significantly higher than controls (455 +/- 21 ml.min-1.kg-1), but the two types of shunts did not further increase cardiac index in either the cirrhotic or the sham-operated rats. After shunting, hepatic arterial flows approximately doubled. Portal tributary blood flows in the end-to-side shunted sham (108 +/- 13 ml.min-1.kg-1) and cirrhotic (139 +/- 19 ml.min-1.kg-1 groups were significantly higher than their respective controls (62 +/- 8 and 76 +/- 5 ml.min-1.kg-1). Portosystemic shunting indices were > 99% in both the end-to-side and side-to-side shunted groups in cirrhotic and sham-operated rats.

CONCLUSIONS

The hyperdynamic circulation in cirrhotic rats was not augmented by portacaval shunting operations (either end-to-side or side-to-side), despite essentially total portosystemic blood diversion. Compensatory increase in the hepatic arterial blood flow to the liver remained intact even in cirrhotic rats. A selective redistribution of cardiac output to the mesenteric vascular bed was observed after the shunting procedure. However, there were no significant differences in hemodynamics between the end-to-side and side-to-side shunted groups.

摘要

背景/目的：肝硬化和门静脉高压与高动力循环相关。门腔分流术被广泛用于预防复发性出血，但这些手术对肝硬化患者血流动力学的影响尚未得到充分阐明。因此，我们比较了端侧和侧侧门腔分流术对正常大鼠和肝硬化大鼠血流动力学的影响。

方法

将Sprague-Dawley大鼠根据所接受的手术分为六组。对胆管结扎诱导的肝硬化大鼠和假手术大鼠均进行端侧或侧侧门腔分流术。采用放射性微球法测量全身和局部血流。

结果

分流大鼠的门静脉压力显著降低。肝硬化大鼠的心指数（557±27ml·min⁻¹·kg⁻¹）显著高于对照组（455±21ml·min⁻¹·kg⁻¹），但两种分流术均未使肝硬化大鼠或假手术大鼠的心指数进一步升高。分流后，肝动脉血流增加约一倍。端侧分流的假手术组（108±13ml·min⁻¹·kg⁻¹）和肝硬化组（139±19ml·min⁻¹·kg⁻¹）的门静脉分支血流显著高于各自对照组（62±8和76±5ml·min⁻¹·kg⁻¹）。肝硬化大鼠和假手术大鼠的端侧和侧侧分流组的门体分流指数均>99%。