Clinical events after transjugular intrahepatic portosystemic shunt:: Correlation with hemodynamic findings
Clinical events after transjugular intrahepatic portosystemic shunt:: Correlation with hemodynamic findings
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DOI：
10.1016/s0016-5085(98)70436-6
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发表时间：
1998-06-01
期刊：
影响因子：
29.4
通讯作者：
Rodés, J
中科院分区：
文献类型：
--
作者：
Casado, M;Bosch, J;Rodés, J
背景和目标：经颈静脉肝内门体分流术（TIPS）越来越多地被使用，但TIPS的血流动力学效应与随访临床事件之间的关系仍不明确。因此，我们研究了TIPS术后门脉高压相关事件的血流动力学相关性。方法：对122例因静脉曲张出血而接受TIPS手术的患者进行前瞻性随访。结果如下：TIPS术后门腔静脉压差（PPG）显著降低（从19.7 ± 4.6 mm Hg降至8.6 ± 2.7 mm Hg; P > 0.001），但此后升高，所有患者再出血时（n = 25）均>12 mm Hg（18.4 ± 4.6 mm Hg）。26名患者出现腹水; PPG（19名患者测量）始终>12 mm Hg。PPG增加至>12 mm Hg的情况非常频繁（1年时为83%）。在1年内，77%的患者接受了球囊血管成形术或再支架术。然而，80%的患者在再次介入后1年再次出现PPG>12 mm Hg。31%的患者在1年时发生肝性脑病; 23例患者中有21例的PPG为
Background & Aims: Transjugular intrahepatic portosystemic shunt (TIPS) procedures are increasingly being used, but the relationship between the hemodynamic effects of TIPS and the clinical events on follow-up remains undefined. Hence, we have investigated the hemodynamic correlations of portal hypertension-related events after a TIPS procedure. Methods: Prospective follow-up of 122 cirrhotic patients who had a TIPS procedure performed because of variceal hemorrhage was conducted. Results: The portacaval pressure gradient (PPG) significantly decreased after the TIPS procedure (from 19.7 +/- 4.6 to 8.6 +/- 2.7 mm Hg; P > 0.001), but increased thereafter and at rebleeding (n = 25) was >12 mm Hg in all patients (18.4 +/- 4.6 mm Hg). Twenty-six patients developed ascites; the PPG (measured in 19) was always >12 mm Hg. Increasing the PPG to >12 mm Hg occurred very frequently (83% at 1 year). Within 1 year, 77% of patients underwent balloon angioplasty or restenting. However, 80% had again a PPG of >12 mm Hg 1 year after reintervention. Hepatic encephalopathy developed in 31% of patients at 1 year; 21 of 23 patients had a PPG of