摘要

背景和目的:在门静脉高压患者中，经颈静脉肝内门静脉系统分流术(TIPS)会急剧增加心输出量并加剧周围血管舒张。有人认为，恶化的高动力状态可能发展为高输出心力衰竭。目的是评估急性和短期血流动力学适应这一程序。方法:在放置TIPS前、放置TIPS后15-30分钟和放置TIPS两个月后，对15例处于稳定血流动力学条件下的肝硬化患者进行全身、内脏和肺血流动力学研究。为了纳入最后的分析，在两个月的随访中，需要一个平稳的tips后和一个稳定的门静脉梯度。测量或计算以下变量:门静脉梯度;心脏指数(热稀释);收缩期和舒张期平均动脉、心房、肺动脉和楔形肺毛细血管压;心率;总外周血管和肺血管阻力。 Blood flow in the shunt was measured using duplex Doppler ultrasound. RESULTS: The portacaval gradient decreased by 56% and remained stable thereafter. Shunt blood flow was unchanged when measured immediately after TIPS and two months later. Immediately after TIPS there was a pronounced increase in cardiac index (+32%; p < 0.05) in association with a decrease in peripheral and pulmonary vascular resistance (-21%; p < 0.05 and -14%; NS). Two months later, whereas the initial rise in cardiac index was attenuated, peripheral vascular resistances remained similar and pulmonary vascular resistances decreased further (-33%; p < 0.05) compared with immediate post-TIPS values. CONCLUSIONS: Hyperdynamic circulation worsened immediately after TIPS, with a progressive adaptation during follow up. The mechanisms of post-TIPS induced haemodynamic changes include an abrupt volume load resulting from splanchnic decompression and an increased delivery of gut derived vasodilators to the systemic circulation. The persistence of decreased peripheral and pulmonary vascular resistances despite the reduction in high cardiac output two months after TIPS suggests that vasodilatation is not solely a compensatory response to a TIPS induced increased preload. Vasodilatory substances shunted away from the liver probably play an important part in this phenomenon.