Effect of Transjugular Intrahepatic Portosystemic Shunt Creation on Pulmonary Gas Exchange in Patients with Hepatopulmonary Syndrome: A Prospective Study
Effect of Transjugular Intrahepatic Portosystemic Shunt Creation on Pulmonary Gas Exchange in Patients with Hepatopulmonary Syndrome: A Prospective Study
复制标题
经颈静脉肝内门体分流术对肝肺综合征患者肺气体交换的影响：一项前瞻性研究
DOI：
10.1016/j.jvir.2018.09.017
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发表时间：
2019-02-01
影响因子：
2.9
通讯作者：
Li, Xiao
中科院分区：
文献类型：
--
作者：
Tsauo, Jiaywei;Zhao, He;Li, Xiao
目的：探讨经颈静脉肝内门静脉系统分流术（TIPS）对肝肺综合征（HPS）患者肺气体交换的影响。材料和方法：2014年6月至2015年6月在单一机构接受选择性TIPS创建的肝硬化或Budd-Chiari综合征患者均符合纳入条件。23例技术成功的HPS患者（年龄55.0 y +/- 14.4； 11例男性；终末期肝病模型评分10.2 +/- 2.7）纳入分析。HPS的诊断是通过对比增强超声心动图显示肺内血管扩张和动脉血气分析显示动脉氧合缺陷。结果：平均门静脉系统梯度从TIPS创建前的21.7 mm Hg +/- 8.3降低到TIPS创建后的10.8 mm Hg +/- 5.1。在5例（21.7%）出现呼吸困难的患者中，4例（80.0%）报告在TIPS创建后改善。在2例（50.0%）患者中，这种改善在TIPS创建后3个月没有保持。与TIPS创建前相比，HPS患者在TIPS创建后1个月（-9.2 mm Hg +/- 8.0; P < 0.001）肺泡动脉氧梯度的平均变化具有统计学意义，但在TIPS创建后2-3天（-0.9 mm Hg +/- 10.5; P = 0.678）或3个月（-3.4 mm Hg +/- 11.8; P = 0.179）无统计学意义。结论：TIPS的产生可短暂改善HPS患者的肺气体交换。
Purpose: To evaluate effect of transjugular intrahepatic portosystemic shunt (TIPS) creation on pulmonary gas exchange in patients with hepatopulmonary syndrome (HPS).Materials and Methods: All patients with cirrhosis or Budd-Chiari syndrome undergoing elective TIPS creation at a single institution between June 2014 and June 2015 were eligible for inclusion. Twenty-three patients with HPS (age 55.0 y +/- 14.4; 11 men; Model for End-Stage Liver Disease score 10.2 +/- 2.7) who achieved technical success were included in the analysis. Diagnosis of HPS was established by contrast-enhanced echocardiography demonstrating intrapulmonary vascular dilatation and arterial blood gas analysis demonstrating arterial oxygenation defects.Results: Mean portosystemic gradient was reduced from 21.7 mm Hg +/- 8.3 before TIPS creation to 10.8 mm Hg +/- 5.1 after TIPS creation. Among the 5 (21.7%) patients who experienced dyspnea, 4 (80.0%) reported improvement after TIPS creation. This improvement was not maintained at 3 months after TIPS creation in 2 (50.0%) patients. Compared with before TIPS creation, mean change in alveolar-arterial oxygen gradient for patients with HPS was statistically significant at 1 month (-9.2 mm Hg +/- 8.0; P < .001) after TIPS creation, but not at 2-3 days (-0.9 mm Hg +/- 10.5; P = .678) or 3 months (-3.4 mm Hg +/- 11.8; P = .179) after TIPS creation.Conclusions: TIPS creation, ian transiently improve pulmonary gas exchange in patients with HPS.