JOURNAL OF KAOHSIUNG MEDICAL ASSOCIATION 2011. vol.20, No.

Hepatopulmonary Syndrome

()

(ARDS)

 compliance

(1)

83%95%(1)

hepatic hydrothorax
( PaO 2 <80 (70)mmHg alveolararterial oxygen gradients > 20 mmHg)
hepatopulmonarysyndrome
protopulmonary hypertension)(1,2)

hepatopulmonarysyndrome
protopulmonaryhypertension

Hepatopulmonary Syndrome 

 10-32 %
hepatopulmonary syndrome
(1)
(2)
(alveolar-arterialoxygengradients>

218

Hepatopulmonary Syndrome--

20mmHg)(3)
(2,3,4)
bacterial
translocation cytolkines
endotoxicin
portosystemic shunt

ionic  nitric oxide


ventilation-perfusion mismatch
right-to-left intrapulmonary shunt
diffusiondefects
platypnea(
)orthodeoxia(
)
 spinder nevi
(1,2,3,4)

room air
P a O 2< 7 0  m m H g

()C o n t r a s t - e n h a n c e d e c h o c a r d i o g r a p h y

P a C O 2 > 4 5  m m H g  F E V 1
intrapulmonary shunt( Ref.3)
< 1 L   A:(microbubbles)
B:
hepatopulmonarysyndrome C:
D:
hepatopulmonary syndrome E:
F:
PaO2<50mmHg
 contrastshunt
e n h a n c e d  e chocar diogr aphy (  

agitated saline)

right-to-left intrapulmonary
(microbubbles)
shunt( ) (3)

shuntcontrast219

 JOURNAL OF KAOHSIUNG MEDICAL ASSOCIATION 2011. vol.20, No.3

xFiO2-PaCO2/0.8)

s h u n t 9 9 m T c
macroaggregated albumin

99m
Tcmacroaggregatedalbumin
shunt
5%()(4)
100%
PaO 2 300mmHg

protopulmonary
hypertension


Hepatopulmonary Syndrome


hepatopulmonarysyndrome
hepatopulmonary syndrome

77%
24%(2)

hepatopulmonary syndrome

(3)
hepatopulmonary

()99mTc Macroaggregated Albumin (MAA)

scintigraphy (Ref.4)

enhanced
contrastenhanced echocardiography

shunt
100%
shunt(Shunt-fraction(Qs/Qt)
5%20%
)(2,3,4)
Qs/Qt=(PAO 2 -PaO 2 )x0.0031x100/
(PAO2-PaO2)x0.0031+5
PAO2=(Barometericpressure-47)

220

Hepatopulmonary Syndrome--

syndrome (PaO 2 <50 mmHg)

67%
30%
30%(2,3)
1999
intrapulmonary shunt 
<20%,20-40%,>40%shunt
>40%
(
80%,66.7%48%)(5)
hepatopulmonary
syndrome
(2,3)

nitricoxidehigh-frequency
oscillator ventilator
hepatopulmonary syndrome

Guptaetal(2010)

93%(2)

hepatopulmonarysyndrome

hepatopulmonary syndrome


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HepatopulmonarySyndrome.AmJ
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Hepatopulmonarysyndromeincreasesthe
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100%oxygen,andbrainuptakeafter99mTc
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