Effects of transjugular intrahepatic portasystemic shunt (TIPS) on splanchnic and systemic hemodynamics, and hepatic function in patients with portal hypertension
Effects of transjugular intrahepatic portasystemic shunt (TIPS) on splanchnic and systemic hemodynamics, and hepatic function in patients with portal hypertension
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经颈静脉肝内门体分流术（TIPS）对门脉高压患者内脏和全身血流动力学及肝功能的影响
DOI：
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发表时间：
1995
影响因子：
3.1
通讯作者：
G. Clemente
中科院分区：
文献类型：
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作者：
J. M. Rodríguez;R. Bañares;A. Echenagusía;M. Casado;F. Camúñez;F. Pérez;A. Diego;E. Cos;G. Clemente
本研究的目的是评估 TIPS 创建后的短期内脏和全身血流动力学以及肝功能。 15 名肝硬化门静脉高压症患者接受了 TIPS 放置治疗静脉曲张出血，并在术前和术后 1 个月进行了广泛的血流动力学研究，包括右心导管插入术、门静脉压力测量、肝血流量和吲哚菁绿 (ICG) 清除率。所有病例均放置自扩张金属支架（Strecker 11 mm 直径）。技术后门体梯度显着减小（18.3±4.2 vs 8±2.8；54%±18 mm Hg），主要是由于门静脉压力下降，并在最终研究中保持稳定。心输出量和平均动脉压增加（分别为6.2±1.4 vs 8.2±1.8升/分钟、80.1±10.1 vs 91±11.2 mm Hg），并且全身血管阻力下降（1018±211 vs 872±168 达因/秒/cm5）；肝血流量和ICG清除率也显着下降（分别为1.5±0.7 vs 0.68±0.2升/分钟，0.4±0.2 vs 0.24±0.06升/分钟）。最终研究中前负荷有所增加，右心房压（3.1±1.6 vs 4.35±2.2 mm Hg，+15%，P<0.05）、肺动脉压（12.2±2.4 vs 15.9±3.2 mm Hg，+31.8%，P<0.001）和楔形肺动脉压显着增加。 （6.9±2.4 对比 9.8±3.1 毫米汞柱，+53%，P<0.001）。这些结果表明，TIPS 会加重与门脉高压相关的高动力综合征。因此，对于心功能不全的患者，应评估该手术。 TIPS 还会减少肝血流量，导致肝功能轻度恶化。
The purpose of this study was to evaluate the short-term splanchnic and systemic hemodynamics and hepatic function after TIPS creation. Fifteen cirrhotics with portal hypertension underwent TIPS placement for treatment of variceal hemorrhage, and extensive hemodynamic studies including right heart catheterization, portal pressure measurement, hepatic blood flow, and indocyanine green (ICG) clearance were performed before and 1 month after the procedure. Self-expandable metal stents (Strecker 11 mm diameter) were placed in all cases. Portasystemic gradient significantly diminished (18.3±4.2 vs 8±2.8; 54%±18 mm Hg) after the technique, mainly due to a decrease in portal pressure, and remained stable in the final study. Cardiac output and mean arterial pressure increased (6.2±1.4 vs 8.2±1.8 liters/min, 80.1±10.1 vs 91±11.2 mm Hg, respectively), and a decrease in systemic vascular resistance was registered (1018±211 vs 872±168 dyne/sec/cm5); the hepatic blood flow and ICG clearance also decreased significantly (1.5±0.7 vs 0.68±0.2 liters/min, 0.4±0.2 vs 0.24 ±0.06 liters/min, respectively). There was an increase in the preload at the final study, as evidenced by a marked increase in right atrial (3.1±1.6 vs 4.35±2.2 mm Hg, +15%,P<0.05), pulmonary arterial (12.2±2.4 vs 15.9±3.2 mm hg, +31.8%,P<0.001), and wedge pulmonary arterial pressures (6.9±2.4 vs 9.8±3.1 mm Hg, +53%,P<0.001). These results suggest that TIPS worsens the hyperdynamic syndrome associated to portal hypertension. Therefore, in patients with cardiac insufficiency, this procedure should be evaluated. TIPS also decreases the hepatic blood flow, inducing a mild worsening in liver function.