| 1 PurposeAfter splenectomy for liver cirrhosis with hypersplenism,there will be obvious hemodynamic and hemorheology changes,which will easily lead to the formation of portal vein thrombosis and blood stasis syndrome.Based on the observation of the physical and chemical properties of blood after splenectomy and the intervention of Jianpi and Huoxue Traditional Chinese medicine on blood stasis syndrome,this paper discusses the effect of splenectomy combined with Jianpi and Huoxue Traditional Chinese medicine on hemodynamics and hemorheology as well as the prevention and treatment of blood stasis syndrome.2 Method2.1 Clinical research2.1.1 Case grouping method:According to the syndrome types after operation,the patients were divided into control group and spleen deficiency and blood stasis group,including 20 cases in control group and 30 cases in spleen deficiency and blood stasis group.The spleen deficiency and blood stasis group were randomly divided into Operation group and Operation+Chinese medicine group,with 15 cases in each group.2.1.2 Treatment methods:①Control group:routine treatment such as liver protection,diuresis and nutrition support before operation;bundle ligation and disconnection of splenic portal blood tube during operation for splenectomy;routine support treatment such as anti infection,fluid supplement and nutrition support after operation,often The amylase in drainage fluid and the thrombus in portal vein system were monitored by color Doppler flow imaging.No portal vein system thrombosis was found and no preventive anticoagulant treatment was given.②Operation group:on the basis of the treatment of the Control group,the thrombus in portal vein was detected by color Doppler flow imaging and low molecular weight heparin was given.③Operation+Chinese medicine group:on the basis of the treatment of the Operation group,the third day after the operation was given Jianpi and Huoxue oral Chinese medicine once a day for 2 weeks.2.1.3 Observation index:① Before and after operation,hemodynamic indexes of proper hepatic artery,portal vein and splenic arteriovenous vessels were monitored before and after operation.②Hemorheology indexes were monitored before and after operation.③ Blood routine,liver function,coagulation routine and D-dimer indexes were monitored before and after operation.④Liver fibrosis indexes were monitored before and after operation.⑤Portal vein thrombosis were monitored after operation.2.1.4 Statistical methods:the measurement data were expressed by means of mean ±standard deviation((?)±s),the data between groups were compared by independent sample t test,the data within groups were compared by paired t test.The single factorχ2 test was used to analyze the related factors that may affect the syndrome of spleen deficiency and blood stasis,and the logistic regression analysis was used to evaluate the influencing factors of the spleen deficiency and blood stasis syndrome,and the changes of hemodynamics and hemorheology before and after operation were systematically evaluated.The statistical tool was SPSS13.0(SPSS,version 13.0,Chicago,IL,USA)software,with the test level[α]=0.05,P<0.05 considered that the difference was statistically significant.2.2 Animal experiments2.2.1 Modeling and grouping method:The model of hypersplenism of liver cirrhosis was established by intraperitoneal injection of 5%thioacetamide(TAA).Thirty New Zealand white rabbits were randomly divided into three groups,10 in each group,which were Control group,Model group and Traditional Chinese medicine group.2.2.2 Intervention methods of each group:Control group:no treatment,free water from the day of the experiment;Model group:the model was established by intraperitoneal injection of 5%TAA.Splenectomy was underwent until 16 weeks after the success of the model.On the day of operation,rabbits in Model group were given free drinking water and food,but not Traditional Chinese medicine;Traditional Chinese medicine group:the methods of modeling and splenectomy were the same as those in the Model group,except that after splenectomy,they were given Jianpi and Huoxue Traditional Chinese medicine from the second day after splenectomy,the dosage was 10g/(kg.d),twice a day,at 9:00 and 15:00 for two weeks respectively.Chinese medicine rewarming before intragastric administration.2.2.3 Observation index:① Before and after operation,hemodynamic indexes of proper hepatic artery,portal vein and splenic arteriovenous vessels were monitored before and after operation.②Hemorheology indexes were monitored before and after operation.③ Blood routine,liver function,coagulation routine and D-dimer indexes were monitored before and after operation.④Liver fibrosis indexes were monitored before and after operation.2.2.4 Statistical methods:the measurement data are usually expressed by means of mean ± standard deviation((?)±s),the data between groups are compared by independent sample t-test,the data within groups are compared by paired t-test,the statistical tool is SPSS13.0(SPSS,version 13.0,Chicago,IL,USA)software,the test level[α]=0.05,P<0.05 considered that the difference was statistically significant.3 Results3.1 Clinical research results3.1.1 Relationship between spleen deficiency and blood stasis syndrome and HemorheologyThe formation of the syndrome of spleen deficiency and blood stasis is closely related to coagulation function and hemorheology.The indexes of FDP,middle shear rate 50,middle shear rate 30,low shear rate 5,low shear rate 1 and ESR have definite diagnostic value for the syndrome of spleen deficiency and blood stasis.Single factor analysis showed that FDP,50,30,5,1 and ESR were the influencing factors of spleen deficiency and blood stasis syndrome(P<0.05).Logistic regression analysis showed that FDP and low shear rate 1 were the independent risk factors of spleen deficiency and blood stasis syndrome(P<0.05).3.1.2 relationship between spleen deficiency and blood stasis syndrome and hemodynamicsThe spleen deficiency and blood stasis syndrome was closely related to hemodynamics.The indexes of hemodynamics,such as the diameter of spleen artery,PSV of spleen artery and Vmax of portal vein,had definite diagnostic value for spleen deficiency and blood stasis syndrome(P<0.05).Single factor analysis suggested that the indexes of hemodynamics,such as the diameter of spleen artery,PSV of spleen artery and Vmax of portal vein,were the influencing factors of spleen deficiency and blood stasis syndrome(P<0.05).Logistic regression analysis showed that spleen artery PSV was the independent risk factor of spleen deficiency and blood stasis syndrome(P<0.05).3.1.3 Changes of blood routine and liver function after splenectomy in patients with cirrhosis and hypersplenismThe blood routine and liver function of the patients before and after the operation were compared.In Operation group,the leukocyte count,platelet count,TBIL,IBIL was better than those before operation,and in Operation+Chinese medicine group,the leukocyte count,platelet count,TBIL,DBIL,IBIL were better than those before operation,the results were statistically significant(P<0.05).3.1.4 The effect of Jianpi and Huoxue Traditional Chinese medicine on the hemodynamics of patients with liver cirrhosis and hypersplenism after splenectomyIn the Operation group,the PSV and the blood flow of proper hepatic artery were were significantly increased,and the Vmax of the portal vein in the Operation group was slightly lower than that before the operation.In the Operation+Chinese medicine group,the diameter of the proper hepatic artery,the PSV of the proper hepatic artery and the blood flow of the proper hepatic artery were significantly increased,and the diameter of the portal vein,the Vmax of the portal vein and the blood flow of the portal vein were slightly decreased,the difference was statistically significant(P<0.05).The PSV and the blood flow of the proper hepatic artery in the Operation+Chinese medicine group were significantly higher than those in the Operation group,and Vmax of portal vein was slightly lower than that of Operation group(P<0.05).3.1.5 Effect of Jianpi and Huoxue Traditional Chinese medicine on Coagulation function and Hemorheology after splenectomy in patients with liver cirrhosis and hypersplenismThe coagulation indexes APTT,FBG,FDP and D-Dimer of patients in 7 days after operation were significantly higher than those before operation.The hemorheology indexes of high shear rate 200,middle shear rate 50,middle shear rate 30,low shear rate 5,low shear rate 1,plasma viscosity and hematocrit were significantly higher than those before operation.The coagulation indexes PT,FBG,FDP and D-Dimer of the patients on the 14th day after operation were all higher than those before operation,and the hemorheology indexes 200,50,30,5,1,rigidity index and deformation index of RBC count were significantly increased compared with those before operation,and the results were statistically significant(P<0.05).The coagulation indexes FBG,FDP and D-Dimer of the patients in the Operation+Chinese medicine group were significantly higher than those before operation on the 7th day after operation.The hemorheology indexes 200,50,30,5,1,and the rigidity index of RBC count were significantly higher than those before operation.The coagulation indexes FBG,FDP and D-Dimer of the patients on the 14th day after operation were higher than those before operation.The hemorheology indexes 200,50,30,rigidity index and deformation index of RBC count were significantly higher than those before operation,and the results were statistically significant(P<0.05).The D-dimer 7 days after surgery in the Operation+Chinese medicine group was significantly lower than that in the Operation group,and the coagulation indicators PT,FDP and D-dimer in the Operation+Chinese medicine group were all lower than those in the Operation group 14 days after surgery,and the difference was statistically significant(P<0.05)3.2 Animal experiment results3.2.1 Effect of splenectomy on blood routine and liver function in cirrhotic rabbits with hypersplenismIn the Control group,the blood routine index hemoglobin concentration was lower than that before splenectomy,and the liver function indexes ALT,AST,TBIL,DBIL were higher than that before operation,ALB was lower than that before operation,the results were statistically significant(P<0.05)In the Model group,the blood routine indexes such as leukocyte count and platelet count were lower than those before model establishment,and the RBC count and hemoglobin concentration were higher than those before model establishment,and the liver function indexes such as ALT,AST,TBIL,DBIL and IBIL were higher than those before model establishment,ALB was lower than those before model establishment,there was significant statistical difference(P<0.05).After splenectomy,the blood routine indicators of white blood cell count and platelet count were higher than those after liver cirrhosis modeling,and the red blood cell count and hemoglobin concentration were lower than those after modeling.The functional indicators AST and TBIL were lower than those after cirrhosis modeling,and the results were significant statistical differences(P<0.05).In the Traditional Chinese medicine group,the blood routine indexes such as white blood cell count and platelet count were lower than those before the establishment of liver cirrhosis model,the blood cell count and hemoglobin concentration were higher than those before the establishment of liver cirrhosis model,and the liver function indexes such as ALT,AST,TBIL,DBIL and IBIL were higher than those before the establishment of liver cirrhosis model,ALB was lower than those before the establishment of liver cirrhosis model,the results showed significant statistical differences(P<0.05).After splenectomy,the blood routine indicators of white blood cell count and platelet count were higher than those after liver cirrhosis modeling,and the red blood cell count and hemoglobin concentration were lower than those after modeling.The functional indicators ALT,AST,and TBIL were lower than those after cirrhosis modeling,and the results were significant statistical differences(P<0.05).Comparison between the Model group and the Traditional Chinese medicine group after splenectomy:ALT,AST,TBIL in the Traditional Chinese medicine group after splenectomy were lower than those in the Model group,and ALB was higher than that in the Model group,with significant statistical difference(P<0.05).3.2.2 Changes of hemodynamics after splenectomy in rabbits with liver cirrhosis and hypersplenismThere was no significant difference among the Control group,the Model group and the Traditional Chinese medicine group before operation(P>0.05).The blood flow of hepatic artery in the Control group was significantly higher than that before operation,while the diameter and blood flow of portal vein were significantly lower than that before operation,the results showed significant statistical difference(P<0.05).In the Model group and the Traditional Chinese medicine group,the PSV and blood flow of hepatic artery decreased significantly after the establishment of liver cirrhosis model(P<0.05).The diameter of portal vein increased,while the Vmax and blood flow of portal vein decreased in cirrhotic model(P<0.05).The PSV,internal diameter and blood flow of splenic artery increased significantly after the establishment of liver cirrhosis model compared with those before the establishment of liver cirrhosis model(P<0.05).The Vmax,diameter and blood flow of splenic vein increased significantly after the establishment of cirrhosis model(P<0.05).In the Model group,the PS V and blood flow of hepatic artery increased and the blood flow of portal vein decreased compared to those after the establishment of cirrhosis model(P<0.05).The PSV of hepatic artery,blood flow and Vmax of portal vein increased and the diameter of portal vein decreased in Traditional Chinese medicine group(P<0.05).Comparison between the Model group and the Traditional Chinese medicine group after splenectomy:the Vmax and blood flow of the portal vein in the Traditional Chinese medicine group after splenectomy were higher than those in the Model group,and the diameter of the portal vein was lower than that in the Model group(P<0.05).3.2.3 Effect of Jianpi and Huoxue method on Coagulation function and Hemorheology after splenectomy in rabbits with liver cirrhosis and hypersplenismIn the Control group,FBG was higher and viscosity of middle section of hemorheology was higher than that before operation,and the results showed significant statistical difference(P<0.05).In the Model group,PT and D-dimer were higher,FBG was lower and hemorheology index was higher,middle,low shear viscosity and plasma viscosity were higher than those before modeling(P<0.05).The degree,plasma viscosity and hematocrit of RBC count were significantly higher than those after the establishment of cirrhosis model,and the results showed significant statistical difference(P<0.05).In the Traditional Chinese medicine group,PT and D-dimer were higher than that before modeling,FBG was lower than that before modeling,high,medium,low shear viscosity and plasma viscosity were higher than before modeling,the results were statistically significant(P<0.05).After splenectomy,the coagulation index PT was lower than that after modeling,and FBG and D-dimer were higher than those after modeling.The hemorheology index hematocrit and deformation index were significantly higher than those after modeling,and the results were statistically significant differences(P<0.05).After splenectomy,the Traditional Chinese medicine group has a higher coagulation index FBG than the Model group,and a lower D-dimer compared to the Model group.Hemorheological indexes such as high,medium and low-shear rate viscosity,plasma viscosity,hematocrit was significantly lower than that of the Model group,and there were significant statistical differences(P<0.05).4 Conclusion4.1 After splenectomy,the syndrome of spleen deficiency and blood stasis is closely related to hemodynamics and hemorheology.Univarate analysis showed that major risk factors of postoperative mortality of the patients were FDP,middle shear rate 50,middle shear rate 30,low shear rate 5,low shear rate 1,ESR,the diameter of splenic artery,PSV of splenic artery and Vmax of portal vein.Multivariate analysis showed that FDP,low shear rate 1,PSV of splenic artery were independent risk factors4.2 Splenectomy can improve the hemogram result of hypersplenism.The disconnected splenic artery and vein can lead to the increase of liver blood flow,thus improving the liver function.At the same time,it can reduce the portal vein blood flow velocity and blood flow,which can easily lead to portal vein thrombosis and blood stasis syndrome.The method of Jianpi and Huoxue method can improve the hemodynamic indexes of hepatic artery,increase the liver blood flow velocity and blood flow,and then restore the liver.4.3 Splenectomy can increase the viscosity of high,medium and low shear rate blood,increase the level of D-dimer and decrease the blood flow velocity of portal vein,which can easily lead to portal vein thrombosis and blood stasis syndrome.The Jianpi and Huoxue method can reduce the coagulation time,D-dimer level and blood viscosity,and then play a role in the prevention and treatment of portal vein thrombosis,alleviate the syndrome of blood stasis as well. |
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