肝有效血流量无创检测在评估术前肝储备功能中的价值

Value of PDD Method for EHBF Test in Evaluating Pre-Operation Hepatic Function Reserve

【目的】探讨肝有效血流量(EHBF)预测手术患者肝储备功能的价值。【方法】以脉搏染料光密度法(PDD)测定57例肝脏手术患者术前EHBF、吲哚菁绿15 min潴留率(R15)并常规检测肝功能指标;按照术前EHBF状况分组,比较术后肝功能不全出现情况并检验EHBF与R15的相关性;按照术后肝功能状况分组,统计比较术前常规肝功能指标、Child分级和EHBF的差别,研究EHBF与肝硬化的关系。【结果】EHBF>1.0 L/min 38例,EHBF<1.0 L/min 19例,两组术后肝功能不全发生率为8.0%,53.8%(P<0.05)。EHBF与R15显著相关(r=-0.6379,P<0.01)。术后肝功能良好、肝功能不全组间术前常规肝功能指标、Child评分无显著差异,而EHBF差异显著(P<0.01)。肝硬化组和无肝硬化组的EHBF差异显著[(0.98±0.39)vs(1.58±0.35)L/min,P<0.01]。【结论】EHBF是预测手术患者肝储备功能的有效指标;PDD法是测定EHBF的无创、简便的方法。

[Objective]To assess the value of pre-operation hepatic function reserve predicted by effective hepatic blood flow（EHBF）. [Methods]Fifty-seven patients who were to accept liver operation were evaluated by pulse dye-densitometry（PDD） method and common liver function test, the indexes including EHBF, R15 and common liver function were compared. The groups were established according to EHBF and post operation hepatic function status. The post- operative liver dysfunction rate was compared in different EHBF groups and the correlation between EHBF and R15 were tested. Meanwhile the pre-operation common liver function indexes, Child score and EHBF were compared in different post-operation liver function group. The correlation between liver cirrhosis and EHBF were tested. [Results]Patients of EHBF〉1. 0 L/min（ n = 38） had a significantly low postoperative liver dysfunction rate compared with those of EHBFG1.0 L/min（ n = 19）（8.0% vs 53.8%, P G0.05）. The pre-operated EHBF and R15 reached significant correlation（r= -0. 6379, P 〈 0.01）. All the pre-operation indexes but EHBF had no statistical difference in compensate and uncompensated group （ P 〈0.01）. EHBF between cirrhosis and normal group had significant difference[（0.98±0.39） vs. （1.58±0.35） L/min, P 〈0.01]. [Conclusion]EHBF test by PDD method is an effective and simple way to assess hepatic function reserve before operation. PDD is a simple and noninvasive method to measure EHBF.