血红蛋白浓度对门静脉高压症高血流动力学状态的影响
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花荣

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The effects of hemoglobin concentration on cirrhosis and portal hypertension associated with hyperdynamic circulation
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    探讨血红蛋白浓度对肝硬化门静脉高压症(PHT)患者高血流动力状态的影响。方法:收集近1年半内接受断流或联合手术治疗的55例PHT患者的资料。按血红蛋白是否低于110g/L分为贫血和非贫血组,检测相关的临床和血流动力学指标,为排除不同肝功能对研究的影响,按Child分级对数据分层后研究血红蛋白对血流动力学的影响。结果:贫血组和非贫血组相比,心排量[(7.4±1.7)L/min vs (6.3±1.9)L/min, P=0.028]和自由门静脉压[(29.1±3.1)mmHg vs (26.8±3.3)mmHg, P=0.012](1mmHg=0.133kPa)明显升高,平均动脉压[(84±10.7)mmHg vs (97.1±12)mmHg, P<0.01]和全身血管阻力[(866±215)dyn/(s·cm5 )vs (1207±317) dyn/(s·cm5) , P<0.01]显著下降。按Child A 和Child BC分层后对数据的分析得出相似的结果。多元回归分析表明,血红蛋白浓度和白(清)蛋白浓度是影响PHT患者全身血管阻力的独立相关因素。结论:贫血会进一步恶化PHT患者的高血流动力状态。血红蛋白浓度是评估PHT患者血流动力学状态的重要参数之一。

    Abstract:

    Objective:To investigate the effects of hemoglobin concentration on portal hypertension associated with hyperdynamic state. Methods:According to blood hemoglobin level below or above 110g/L, 55 nontreated portal hypertension patients were divided into anemic and nonanemic groups, and the relevant hemodynamic and clinical data were examined and analyzed retrospectively. In order to avoid the effects of differences in hepatic function, data were analyzed separately according to the Child class. Results:Compared to the nonanemic group, the anemic group had markedly increased cardiac output [(7.4±1.7L)/min vs (6.3±1.9L)/min, P=0.028] and increased free portal pressure [(29.1±3.1)mmHg vs (26.8±3.3)mmHg, P=0.012], and a markedly decreased mean arterial pressure [(84±10.7)mmHg vs (97.1±12)mmHg, P<0.01] and systemic vascular resistance [(866±215)dyn/(s·cm5)vs (1207±317) dyn/(s·cm5), P<0.01]. Similar results were obtained when Child A and Child BC patients were analyzed separately. Multivariate logistic regression disclosed that hemoglobin concentration, as well as albumin concentration, was an independent factor influencing the systemic vascular resistance in PHT patients. Conclusions:Anemia further aggravates the hyperdynamic circulation of portal hypertension. Hemoglobin concentration is an important parameter to evaluate the hemodynamic status of PHT patients.

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花荣,曹晖,吴志勇.血红蛋白浓度对门静脉高压症高血流动力学状态的影响[J].中国普通外科杂志,2005,14(12):8-908.
DOI:10.7659/j. issn.1005-6947.2005.12.008

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  • 在线发布日期: 2005-12-25