[1]陈静,肖天利,龙庆林,等.经颈静脉不同门静脉分支穿刺分流对肝硬化患者血氨水平的影响[J].第三军医大学学报,2018,40(07):610-613.
 CHEN Jing,XIAO Tianli,LONG Qinglin,et al.Effect of transjugular intrahepatic portosystemic shunt placement in different branches of portal vein on plasma ammonia level in cirrhotic patients[J].J Third Mil Med Univ,2018,40(07):610-613.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
40卷
期数:
2018年第07期
页码:
610-613
栏目:
临床医学
出版日期:
2018-04-15

文章信息/Info

Title:
Effect of transjugular intrahepatic portosystemic shunt placement in different branches of portal vein on plasma ammonia level in cirrhotic patients
作者:
陈静肖天利龙庆林陈文生陈磊
陆军军医大学(第三军医大学)第一附属医院全军消化病研究所
Author(s):
CHEN Jing XIAO Tianli LONG Qinglin CHEN Wensheng CHEN Lei

Institute of Gastroenterology, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

关键词:
经静脉肝内门体分流术肝性脑病门静脉系统血氨
Keywords:
transjugular intrahepatic portosystemic shunt hepatic encephalopathy portal vein ammonia
分类号:
R446.112; R472.9; R575.2
文献标志码:
A
摘要:

目的     观察经颈静脉肝内门体分流(transjugular intrahepatic portosystemic shunt,TIPSS)术后患者不同门静脉分支血氨的浓度,探讨不同门脉分支分流对肝硬化患者血氨水平的影响。方法     回顾性分析2016年1-12月本科收治的因消化道出血接受TIPSS的52例肝硬化患者的临床资料。根据TIPSS穿刺部位分为门脉左支组和门脉右支组,术中采集门静脉左支、右支及肠系膜上静脉和脾静脉的血液样本,检测不同部位血氨浓度,并对患者术前和术后1 d、1个月、3个月和半年的动脉血和静脉血的血氨水平进行检测和比较。结果     门静脉系统中肠系膜上静脉的血氨浓度最高,门脉左支的平均血氨浓度显著低于右支(P<0.05)。TIPSS术后动脉血氨浓度明显升高,术后1 d[(57.1±12.7)μmol/L vs(47.1±9.9)μmol/L]和1个月[(51.4±11.8)μmol/L vs (43.6±9.2)μmol/L]时右支组患者动脉血氨明显高于左支组(P<0.01);而静脉血氨浓度变化不明显(P>0.05)。结论     TIPSS手术能明显升高患者的动脉血氨浓度,经左支分流对血氨的影响小于经右支分流。

Abstract:

Objective     To observe the ammonia level of different branches of the portal vein (PV) in cirrhotic patients after transjugular intrahepatic portosystemic shunt (TIPSS) placement and determine the effect of TIPSS placement in different branches on ammonia level. Methods    A retrospective study was carried out on 52 cirrhotic patients who received TIPSS placement for hemorrhage in digestive tract in our institute from January to December 2016. Their clinical data were collected, and assigned into the group of left branch of PV and the group of right branch according to the branch of PV in which the TIPSS was placed. Blood samples were collected from different branches of the PV, the splenic vein and the superior mesenteric vein (SMV), and blood ammonia concentrations were measured during the TIPSS procedure. The arterial and venous ammonia levels were also measured before and in 1 d and 1, 3 and 6 months after TIPSS placement. The results were compared between the 2 groups. Results    Ammonia concentrations were found at the highest level in the PV system, with that in the left branch significantly lower than that in the right (P<0.05). After TIPSS placement, the arterial ammonia concentration was increased obviously, and the levels at 1 d (57.1±12.7 vs 47.1±9.9 μmol/L) and 1 month (51.4±11.8 vs 43.6±9.2 μmol/L) were significant higher in the group of right branch of PV than the group of left branch  (P<0.05), but no such differences were found in the venous blood (P>0.05). Conclusion     TIPSS procedure obviously results in elevated arterial ammonia concentration, and the procedure in the left branch of the PV exerts less effect on the level than it in the right branch.
 

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更新日期/Last Update: 2018-04-10