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?Hepatopulmonary syndrome (hepatopulmonary

?Check that the breath, breathing difficulties, syndrome, low oxygen
?Hepatopulmonary syndrome
(hepatopulmonary syndrome, HPS)
? 1. What is the hepatopulmonary syndrome?
Hepatopulmonary syndrome (hepatopulmonary syndrome, HPS) not only to
patients with chronic liver lung blood vessels as a result of the
expansion of hypoxemia, is a variety of chronic liver disease stage
of a serious complications. Rrowka pointed out, the determining
factor is the HRS of portal hypertension rather extensive necrosis of
2. the hepatopulmonary syndrome pathogenesis
Hepatopulmonary syndrome hypoxemia exact mechanism is currently
disputed. Now that is mainly due to the intrapulmonary shunt,
ventilation perfusion imbalances, pulmonary oxygen diffusion barriers
caused by three factors. Its roots lie in the expansion of the
pulmonary arteries. About pulmonary blood flow has 3 types:
utilization of antihypertensives in respiratory medicine Li Tian
1. the "Anatomy" stream: that is, true streaming, pulmonary blood
vessels away from the respiratory units larger vein between traffic
or arteriovenous malformations. This kind of streaming through the
oxygen cannot correct hypoxemia.
2, "" physiological "stream: the blood flowing through non-ventilated,
oxygen inhalation alveolar.
3, the "functional" triage: V/Q imbalance. When the oxygen molecule
vascular dilatation is rapidly spread to the blood vessels, Central
and hemoglobin combined with reduced due to oxygen; inhalation with
oxygen, oxygen diffusion power increase, systemic and pulmonary blood
flow is reduced, the expansion of capillaries, oxygen and hemoglobin
combined with shorter, insufficient oxygenation, hypoxemia.
3. the hepatopulmonary syndrome clinical manifestations
Hepatopulmonary syndrome in patients with liver disease patients in
occupies about 30%.
The main clinical features are:
(1) there is a clear history of chronic liver disease and its
symptoms, signs, arterial oxygen pressure drop or alveolar-arterial
oxygen pressure increases, pulmonary vascular dilatation of the
(2) the hepatopulmonary Syndrome Foundation is the cause of chronic
liver disease, cirrhosis, therefore the majority of patients have
chronic liver disease, cirrhosis, then gradually emerging respiratory
symptoms such as shortness of breath, cyanosis, etc.
(3) progressive dyspnea hepatopulmonary syndrome is the most common
symptom of lung, orthostatic hypoxia hepatopulmonary syndrome is the
most important characteristic. Physical examination is usually no
obvious exceptions.
4. the hepatopulmonary syndrome diagnosis
HPS (hepatopulmonary syndrome), there is no uniform diagnostic
criteria. Roisin, proposed diagnostic criteria:
1. chronic liver disease or severe liver disease, with or without
severe hepatic insufficiency.
2, no essential heart lung disease;
3, pulmonary gas exchange exception, with or without hypoxemia,
alveolar-arterial oxygen gradient was listed (greater than or equal
to 2.0kpa);
4, extrapulmonary vein effective radionuclide markers or twodimensional echocardiography-positive pulmonary vascular, tips.
Domestic LUs to P (A-a) O2 ≥ 2.67kPa diagnostic criteria as HPS,
local hospitals have the knowledge and guidance role.
In clinic is visible in patients with cirrhosis causes a rapid
emergence "Ming" mouth nails cyanosis, cyanosis inhalation of high
concentration of oxygen is still not correct, you should consider for
5. the hepatopulmonary syndrome secondary to check
1, arterial blood gas analysis: 10Kpa PaO2 less than normal. Upright
and supine PaO2 determination and breathing indoor air and 100%
oxygen is PaO2 valuable. Alveolar-arterial oxygen pressure
differential (AaDD2) often greater than the increase of its gradient
2.0Kpa, and liver disease severity and system hemodynamics, AaDD2 a
PaO2 more sensitive, and can be used as the primary diagnosis on the
basis of HPS.
2, echocardiographic soil: ultrasound examination except negative
basic to HPS. With normal saline, 20% Mannitol or indocyanine green
produces 60-90um microbubbles intravenous, normally micro-bubble
could not adopt the alveolar capillaries (diameter 8-15um) arrives at
the heart of the system.
3. for radionuclide scanning: 99m technetium-tag-albumin-scan, the
principle is similar with ultrasound examination. Hypoxemia cirrhosis,
the scan results-tips has a significant expansion of pulmonary artery,
resulting in negative does not except HPS.
4, pulmonary angiography: can distinguish between diffuse
distribution of spider-like vascular dilatation, cavernous vein
dilation and discontinuous arteriovenous traffic on choose of liver
transplantation and clinical prediction has significant value.
5, other: chest x-ray, CT and pathological changes in check. Chest xray findings of which are: A, the following lung fields as diffuse
small chestnut granular shadows; B, C, pulmonary artery dilation;
enhance lung texture.
6. the hepatopulmonary syndrome treatment
Currently, Hepatorenal syndrome (HPS) pathogenesis is not entirely
clarified that the treatment effect is not very satisfactory. At
present mainly correct hypoxemia and treatment of liver primary
disease. There have been reports of hyperbaric oxygen therapy and for
early patients seems to be correct hypoxemia. Anatomy for pulmonary
arteriovenous shunt that beams available interventional therapy with
people spring ring, gelatin sponge, Embolic, thus blocking the flow
to improve oxygenation, correct hypoxemia, can avoid surgery. Liver
transplantation may improve hypoxemia, is an effective method of
treatment of HPS; drug therapy can try Ami de forest-formyl acid, 50100mg oral,/d 2-3 times, 3-5 weeks, may improve lung ventilation/flow
ratio, PaO2 rise; earthworm stomp acemetacin, Octreotide, garlic and
other drugs may also be subject to further evaluation, the curative
effect. HPS fatality has been reported up to 36.7%.
?Check that the breath, breathing difficulties, syndrome, low oxygen
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