Free Portal Pressure Measurement And Its Clinical Significance After Hassab Of Portal Hypertension

Objective:Pathogenesis of portal hypertension(PHT) is complex.the most si gnificant pathological physiological change is the portal vein pressure higher than normal. Free portal pressure(FPP) can be measured directly by the spleen venipuncture after splenectomy and Hassab.Hemodynamics of PHT is significantly different between personalities,and FPP changes of postoperative is unclear at present,so direct measure the FPP has important significance. This study meas ured FPP of postoperative directly by splenic venous catheter,also investigate the changes of postoperative FPP and its significance,in order to provide more basis for the research of PHT hemodynamics.Methods:Selected 20 PHT patients who received open splenectomy as well as Hassab.Before operation,we measured preoperative FPP via a cannula was inserted into the venae gastroepiploica dextra,and measured postoperative FPP by the indwelling central venous catheter in splenic vein. First days after surgery,we measured FPP on an empty stomach, and measured 24 hours FPP on sixth day after surgery(the first time measurement at 9 am, soon afterwards measure FPP per hour),meanwhile measured the patient’s blood pressure and heart rate from 0 at night to the next morning at 8.Using SPSS17.0 statistical software for statist ical analysis of the result of the measurement.Results:Total patients with PHT postoperative FPP measurement was succeed, no portal vein infection, no bleeding,splenic venous cannula did not appear jams and emergence of ahead of time.All of the patients were not found portal vein thrombosis in 2 weeks after surgery,splenic venous cannula was removed success fully.Followed up for 1 month after discharge, all patients recovered well.The preoperative and postoperative FPP measured results of all patient’s are as follows:(1)The comparison between preoperative FPP and the FPP of empty stomach on first day after surgery:preoperative FPP was 33.3955.282 cm H2O,postoperative FPP was 27.045±4.992 cm H2O,preoperative and postoperative FPP levels have sig nificant differences,postoperative FPP significantly lower than the preoperativ e, proved splenectomy and Hassab can effectively reduce the patients with portal vein pressure.(2)The comparison between normal FPP and the FPP of empty stomach on first day after surgery:the FPP of a normal adult is18 cm H2O,the FPP on first day after surgery was 27.045±4.992 cm H2O,postoperative FPP still significantly higher than the normal FPP,there exists significant difference between the normal FPP and postoperative FPP(P<0.05).(3) 24 hours dynamic graph of FPP on sixth day after surgery: patient’s FPP showed two different levels in two period presents,from 9 to 21 FPP was higher,22 to the next morning at 8 FPP was lower.(4)Correlation analysis between FPP and heart rate as well as mean arterial pressure:simple linear correlation analysis showed that there was a certain positive correlation between patient’s FPP and heart rate,but the cor-relation has no significant(r=0.21,P<0.01),FPP and mean arterial pressure also has a certain positive correlation,but the correlation also has no significant(r=0.38,P<0.01).Conclusion:Directiy measured the FPP of postoperative confirmed splenecto my and Hassab can effectively reduced portal vein pressure,but the operation can’t bring it down to normal levels,surgery can only take temporary solution not effect a permanent cure. The changes of FPP level exhibited daily rhythmicity.Directly measured FPP can real-time, accurate, dynamic monitoring of the portal vein pressure level,to guide the dosage of drug for postoperative drug therapy.Measurement of FPP provides certain scientific basis for hemodynamic study and treatment of PHT.