24 KB100 KB23 KB192920262006Dajčman, Davorinletnik:75str. II-15-II-19številka:supl. 2ISSN:1318-0347COBISSID:2494271URN:URN:NBN:SI:doc-KUKSZCFGslSlovensko zdravniško društvoZdravniški vestnikciroza jeterdiagnosisDiagnostic Techniques and ProceduresDiagnostične metode in postopkiDiagnostikaHepatopulmonalni sindromHepatopulmonary SyndromejetraJetra, cirozaLiver CirrhosismortalityUmrljivostOdkrivanje hepatopulmonalnega sindroma pri bolnikih z jetrno cirozo| Detection of hepatopulmonary syndrome in patient with liver cirrhosis|Background. Hepatopulmonary syndrome (HPS) is a pulmonary vascular disorder, complicating hepatic disease, and is responsible for an increased morbidity and mortality among patients awaiting liver transplantation. Nowadays, it is recognized as an independent risk factor for death in this patient population. The severity of hypoxemia and the advanced stage of the liver dysfunction are determinants for the prognosis. Therefore, the possibility to be successful, thus improving survival, consists of addressing HPS at an earlier stage, giving more attention to moderate evidences of this pathology instead of the severe ones. Patients and methods. Between the year 2000 and first half of the year 2005 we observed 115 patients with liver cirrhosis B and C expressed as class of Child-Pough classification of different etiology and portal hypertension (63 men and 52 women). All patients were included on the basis of inclusion and eyclusion criterion. Results. Clinically we suspected on hepatopulmonary syndrome in 18 patients. With 100 % oxygen inhalation test we confirmed the hepatopulmonary syndrome in 9 patients (57.7 %), 6 men and 3 women, on the other hand contrast echosonography was positive in 8 patients (51.3 %), 5 men and 3 women. All these patients had liver cirrhosis grade C, expressed as class of Child-Pough. Conclusions. On the basis of scientific evidence, we suggest a sample for detecting HPS among patients with liver cirrhosis, founded on the integration of two main factors: the severity of hepatic disease, expressed as class of Child-Pough, and the severity of the hypoxemia. The key role in diagnosis of hepatopulmonary syndrome are anamnesis of platipnea and arterial blood oxygen analysis as a less invasive diagnostic methods. However final diagnosis is achieved with 100 % oxygen inhalation test and contrast echosonographyIzhodišča. Hepatopulmonalni sindrom je posledica sprememb v pljučnem ožilju, ki se pojavijo kot zaplet kronične jetrne bolezni. Zvečuje smrtnost med bolniki z jetrno cirozo, še posebej tistimi, ki čakajo na presaditev jeter. Danes je znano, da pri teh bolnikih predstavlja povsem neodvisni dejavnik tveganja za smrt, stopnja hipoksemije in napredovalost jetrne okvare pa imata največji vpliv na prognozo bolnika. Izboljšanje preživetja kroničnih jetrnih bolnikov je zato odvisno od zgodnjega odkrivanja hepatopulmonalnega sindroma pri manj razvitih oblikah jetrne bolezni. Bolniki in metode. V obdobju med letom 2000 in prvi polovici leta 2005 smo opazovali 115 bolnikov z jetrno cirozo, in sicer 63 moških in 52 žensk, starih med 29 in 67 let, z jetrno cirozo stopnje B ali C po Child-Poughovi klasifikaciji zaradi različnih vzrokov in portalno hipertenzijo. V opazovano skupino so bili vključeni bolniki na podlagi vključitvenega in izključitvenega merila. Rezultati. Klinično smo posumili na hepatopulmonalni sindrom pri 18 bolnikih. Med 18 bolniki smo s testom vdihavanja 100 % kisika potrdili znake HPS pri 9 (57,7 %) bolnikih; 6 moških in 3 ženskah, medtem ko je ultrazvočna preiskava srca s kontrastom bila značilna za HPS pri 8 (51,3 %) bolnikih; 5 moških in 3 ženskah. Vseh 18 bolnikov je imelo jetrno cirozo stopnje C po klasifikaciji Child-Pough. Zaključki. Na podlagi številnih izsledkov predlagamo način zgodnjega odkrivanja hepatopulmonalnega sindroma ob upoštevanju stadija jetrne bolezni po klasifikaciji Child-Pough in izražene hipoksemije. Pravilna anamneza o platipneji in plinska analiza arterijske krvi kot hitro dostopni preiskavi brez ali z majhno invazivnostjo imata ključno vlogo pri presejanju bolnikov z jetrno cirozo in razvojem HPS, ki ga dokončno opredelimo s testom vdihavanja 100-odstotnega kisika in ultrazvočno preiskavo srca s kontrastomTEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo