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目的观察血管紧张素转换酶抑制剂对肝硬化门静脉高压症门静脉血流动力学的影响,探讨血管紧张素转换酶抑制剂治疗肝硬化门静脉高压症的有效性及机制。方法肝硬化门静脉高压症患者80例,在服用血管紧张素转换酶抑制剂后不同时期,用彩色多普勒超声测量门静脉最大血流速度和门静脉血流量。用放射免疫法测定血浆肾素活性和醛固酮浓度。结果脾切除加断流术的肝硬化患者16例,应用血管紧张素转换酶抑制剂后30分钟、60分钟、1周时,门静脉压力分别下降0.45±0.34 kPa(P<0.05)、0.52±0.32 kPa(P<0.05)、0.43±0.24 kPa(P<0.05),门静脉血流量、最大血流速度较用药前略有增加,但无统计学意义。血浆肾素活性从4±2 mg/ml·h 升高到14±6 mg/ml·h(P<0.05),血浆醛固酮浓度从125±5ng/L 下降到45±4ng/L(P<0.05),未见明显副作用。结论血管紧张素转换酶抑制剂能快速降低门静脉压,不减少门静脉血流量,长期应用降低门静脉压力效果明显。
Objective To investigate the effects of angiotensin converting enzyme inhibitors on portal hemodynamics in cirrhotic patients with portal hypertension and to explore the efficacy and mechanism of angiotensin converting enzyme inhibitors in the treatment of patients with cirrhosis and portal hypertension. Methods Eighty patients with cirrhosis and portal hypertension were enrolled in this study. The portal venous blood flow and portal vein blood flow were measured by color Doppler sonography at different time points after administration of angiotensin converting enzyme inhibitors. Plasma renin activity and aldosterone concentration were measured by radioimmunoassay. Results Sixteen patients with hepatic cirrhosis underwent splenectomy plus ablation, the portal pressure decreased 0.45 ± 0.34 kPa (P <0.05), 0.52 ± 0.32 (P <0.05) at 30 minutes, 60 minutes and 1 week after administration of angiotensin converting enzyme inhibitor kPa (P <0.05), 0.43 ± 0.24 kPa (P <0.05). There was a slight increase of portal blood flow and maximum blood flow velocity before treatment, but there was no statistical significance. Plasma renin activity increased from 4 ± 2 mg / ml · h to 14 ± 6 mg / ml · h (P <0.05) and plasma aldosterone concentration decreased from 125 ± 5 ng / L to 45 ± 4 ng / L (P <0.05 ), No obvious side effects. Conclusion Angiotensin converting enzyme inhibitors can rapidly reduce portal pressure without decreasing portal vein blood flow, and long-term application of portal hypertension can significantly reduce portal pressure.