吳亞麗

[摘要] 目的 探討彩色多普勒檢測(cè)老年肝硬化患者門脈血流動(dòng)力學(xué)改變的臨床意義。 方法2016年2月—2018年2月，隨機(jī)選取80例老年肝硬化患者為觀察組，并根據(jù)Child-Pug h肝功能分級(jí)標(biāo)準(zhǔn)分為 3 組；再選取80例肝功能正常為對(duì)照組，對(duì)兩組病例分別測(cè)量門靜脈內(nèi)徑（DPV）、血流速度（VPV）、血流量（QPV）、脾靜脈內(nèi)徑（DSV）、血流速度（VSV）、血流量（QSV）。并將觀察組根據(jù)患者近兩年病史，分為有出血史組和無(wú)出血史組，比較其門靜脈、脾靜脈內(nèi)徑。結(jié)果 觀察組肝硬化患者DPV平均值為（1.45±0.16）cm，對(duì)照組為（1.07±0.14）cm，差異有統(tǒng)計(jì)學(xué)意義（t=3.932，P <0.05）。觀察組肝硬化患者DSV平均值為（1.3±0.08）cm，對(duì)照組為（0.72±0.10，差異有統(tǒng)計(jì)學(xué)意義（t=5.445，P <0.05）。觀察組中不同肝功能分組間存在差異，觀察組隨著Child-Pugh肝功能分級(jí)A、B、C的升高， DPV、 DSV逐漸增寬，VPV、VSV逐漸減慢，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。觀察組隨著Child-Pugh肝功能分級(jí)A、B、C的升高，QPV增加不明顯，差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。有出血史組患者DPV、DSV大于無(wú)出血史組， 差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。 結(jié)論 老年肝硬化患者血流動(dòng)力學(xué)變化與其肝功能分級(jí)相關(guān)，門靜脈、脾靜脈及肝功能分級(jí)為老年肝硬化并發(fā)出血的相關(guān)危險(xiǎn)因素；彩色多普勒檢測(cè)門脈血流動(dòng)力學(xué)在評(píng)估患者門脈高壓有重要臨床意義，具有無(wú)創(chuàng)、可重復(fù)及較高準(zhǔn)確性的優(yōu)點(diǎn)。

[關(guān)鍵詞] 老年肝硬化；門脈系統(tǒng)血流；血流動(dòng)力學(xué)；彩色多普勒

[中圖分類號(hào)] R575.2 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-0742（2019）02（b）-0182-03

Color Doppler Detection of Portal Hemodynamics in Elderly Patients with Cirrhosis

WU Ya-li

Department of Functional Medicine， Leshan Traditional Chinese Medicine Hospital， Leshan， Sichuan Province， 614000 China

[Abstract] Objective To investigate the clinical significance of color Doppler in detecting portal hemodynamic changes in elderly patients with cirrhosis. Methods From February 2016 to February 2018， 80 elderly patients with cirrhosis were randomly selected as observation group， and divided into 3 groups according to Child-Pug h liver function grading criteria. 80 patients with normal liver function were selected as control group. Portal vein diameter （DPV）， blood flow velocity （VPV）， blood flow （QPV）， spleen vein diameter （DSV）， blood flow velocity （VSV）， and blood flow （QSV） were measured in the two groups. The observation group was divided into the hemorrhagic history group and the non-bleeding history group according to the patient's medical history in the past two years， and the inner diameter of the portal vein and splenic vein were compared. Results The mean DPV of the patients with cirrhosis was （1.45±0.16）cm in the observation group（1.07±0.14）cm in the control group. The difference was statistically significant （P<0.05）. The mean DSV of the patients with cirrhosis was （1.3±0.08）cm in the observation group， （0.72±0.10）cm in the control group. The difference was statistically significant （t=5.445，P<0.05）. There were differences in different liver function groups in the observation group with the increase of Child-Pugh liver function grades A， B， and C， DPV and DSV gradually widened， and VPV and VSV gradually decreased， which the differece was statistically significant （P<0.05）. With the increase of Child-Pugh liver function grades A， B， and C， the QPV increase was not significant， the differece was no statistical significance （P>0.05）. Patients with hemorrhage history had higher DPV and DSV than those without hemorrhage， the differece was statistically significant （P<0.05）. Conclusion The hemodynamic changes in elderly patients with cirrhosis are related to the grade of liver function. The portal vein， splenic vein and liver function are graded as the risk factors for cirrhosis in the elderly and blood. The color Doppler is used to detect the portal hemodynamics pulse hypertension， which has important clinical significance and has the advantages of non-invasive， repeatable and high accuracy.