脉动色素浓度测定法检测有效肝脏血流量对肝病患者的临床意义

Clinical significance of pulse dye densitometry in effective hepatic blood flow detection

目的介绍一种肝储备功能与肝脏有效血流量(effective hepatic blood flow,EHBF)的检测方法,探讨其临床意义。方法采用脉动色素浓度测定法(pulse dye densitometry,PDD)和传统的分光光度仪比色法同时检测92例患者吲哚菁绿(indocyanine green,ICG)15min滞留率(ICGR15),分析检测结果的相关性;采用PDD法检测1181例肝癌、85例门脉高压和120例肝血管瘤患者ICGR15、ICG清除率(K)、全身血容量(BV)、心输出量(CO)及EHBF。结果PDD测定法检测的ICGR15与分光光度仪比色法的测定结果显著相关(y=0.789x+2.109,r=0.945,P<0.01)。肝癌和门脉高压患者EHBF较肝血管瘤组显著降低,ICGR15和CO显著升高。ICGR15值小于10%的肝癌患者EHBF平均为1.233L/min,EHBF随着ICGR15的升高显著降低;60岁以上肝癌患者K值、CO和EHBF较60岁以下组均显著降低。结论脉动色素浓度测定法具有无创、实时、便捷等优点,检测的各项数据对评估肝储备功能和EHBF,把握手术方式和范围有一定的参考价值。

Objective To introduce a new method for measuring hepatic reserve function and effective hepatic blood flow （EHBF）, and to assess its clinical significance. Methoc/s The correlation between indoeyanine green retention/ate at 15 min （ICGR15） measured by pulse dye densitometry （PDD） and spectropbotometry was analyzed in 92 patients. 1181 patients with hepatocellular carcinoma （HCC）, 85 patients with portal hypertension and 120 patients with hepatic hemangioma were enrolled in this study. ICGR15, plasma dye clearance rate （K）, blood volume （BV）, cardiac output （CO） and EHBF were detected by PDD. Results ICGR15 measured by spectrophotometry in vitro in blood samples was significantly correlated with that obtained by PDD method （ y = 0. 789x ＋ 2. 109, r = 0. 945, P 〈 0.01 ）. EHBF obtained from patients with HCC or portal hypertension were obviously lower than those fiom patients with hepatic hemangioma, but ICGR15 and CO in the two groups were higher than those in the hepatic hemangioma group. The mean value of EHBF from patients with HCC was 1. 233 L/rain when ICGR15 was /ess than 10%. EHBF decreased with the increase of ICGR15. K, CO and EHBF in HCC patients above the age of 60 were significantly lower than those in patients below the age of 60. Conclusion PDD is a kind of noninvasive, real-time and convenient approach to assess hepatic reserve function and EHBF, which is helpful for surgeons to decide the range of operation.