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

陈静; 肖天利; 龙庆林; 陈文生; 陈磊

doi:10.16016/j.1000-5404.201711046

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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

临床医学 | 更新时间：2026-01-09

- 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
- Effect of transjugular intrahepatic portosystemic shunt placement in different branches of portal vein on plasma ammonia level in cirrhotic patients
- 第三军医大学学报 2018年40卷第7期页码：610-613
- 作者机构：
  
  400038 重庆，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
- 作者简介：
  
  [陈磊，E-mail：chenlei1977603@126.com CHEN Lei, E-mail: chenlei1977603@126.com
- 基金信息：
  
  第三军医大学西南医院院管课题(SWH2013LC06)
- DOI：10.16016/j.1000-5404.201711046
  中图分类号： R446.112;R472.9;R575.2
- 收稿：2017-12-01，
  
  修回：2018-01-02，
  
  纸质出版：2018-04-15
- 稿件说明：
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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(7):610-613.

Jing CHEN, Tianli XIAO, Qinglin LONG, et al. Effect of transjugular intrahepatic portosystemic shunt placement in different branches of portal vein on plasma ammonia level in cirrhotic patients[J]. Journal of Third Military Medical University, 2018, 40(7): 610-613.
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(7):610-613. DOI： 10.16016/j.1000-5404.201711046.

Jing CHEN, Tianli XIAO, Qinglin LONG, et al. Effect of transjugular intrahepatic portosystemic shunt placement in different branches of portal vein on plasma ammonia level in cirrhotic patients[J]. Journal of Third Military Medical University, 2018, 40(7): 610-613. DOI： 10.16016/j.1000-5404.201711046.

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(

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

(47.1±9.9)μmol/L

]

和1个月[(51.4±11.8)μmol/L

(43.6±9.2)μmol/L

]

时右支组患者动脉血氨明显高于左支组(

0.01)；而静脉血氨浓度变化不明显(

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 (

0.05). After TIPSS placement

the arterial ammonia concentration was increased obviously

and the levels at 1 d (57.1±12.7

47.1±9.9 μmol/L) and 1 month (51.4±11.8

43.6±9.2 μmol/L) were significant higher in the group of right branch of PV than the group of left branch (

0.05)

but no such differences were found in the venous blood (

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.

关键词

Keywords

references

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