导管定位动态取血检测肝脏吲哚青绿代谢提取率在肝病患者诊治中的应用

The application of continuous determination of indocyanine green metabolism in liver by new vena cava catheter

目的：导管定位动态取血观测肝脏吲哚青绿（ＩＣＧ）代谢提取率（ＩＣＧＥＲ），用以指导肝病的诊断与治疗。方法：①导管制作：选双腔腔静脉导管，距顶端开口６５ｍｍ处新造开口（４ｍｍ×３ｍｍ），使新造口和顶端开口二者都独立与相关管腔相通。②置管定位：导管置入腔静脉后，使双腔管充满导电液体，并分别通过金属接头与心电监护仪胸前导联相连，显示心内心电特征，并以此为依据调整导管，使导管顶端开口位于下腔静脉与右房交界处（Ｅ），新造开口位于上腔静脉内（Ａ）。③静脉注射ＩＣＧ后分别在５、１０和１５分钟时，同时从Ａ、Ｅ两点取血样检测。④肝静脉血ＩＣＧ浓度（ＩＣＧＨＶ）＝２．４Ｅ－１．４Ａ，ＩＣＧＥＲ＝（Ａ－Ｅ）／Ａ×２４０％。结果：①２５例（３１次）检测，Ａ、Ｅ两点取血９０对，有浓度差８６对（９５．６％），每组３次浓度２０分钟内呈指数函数下降且互相平行。②ＩＣＥＥＲ与ＩＣＧ１５分钟滞留率（ＩＣＧＲ１５）呈明显负相关（Ｐ＜０．００１）。③ＩＣＧＥＲ与ＩＣＧ消失率（ＩＣＧＫ）呈明显正相关（Ｐ＜０．００１）。④ＩＣＧＥＲ检测数据与肝功能状态和发展趋势基本相符。结论：依据心内心电特征定位自制静脉导管，检测ＩＣＧＥＲ具有方便、可靠、准确的特点?

Objective:To assist the diagnosis and treatment of liver diseases by observing the extraction of indocyanine green (ICGER) metabolism by vena cava catheter.Methods:(1)To select a doublelumen catheter,and a new hole (4 mm×3 mm)was made at 65 mm from its tip (A).The new hole and the hole of the tip were separately connected to their lumens.(2) After inserting a catheter into the superior vena cavlectrolytic fluid.ECG should show the characteristics of intracardiac situation.Then tip was adjusted that it should lie between the interior vena cava and the right atrium(E).(3)Blood samples were simultaneously obtained from A and E positions at 5,10,and 15 minutes after indocyanine green(ICG) injection.(4) ICG concentration of hepatic venous blood (ICGHV) was calculated according to the following formula:ICGHV=2 4 E-1 4 A,and ICGER=(A-E)/A×240% of hepatic venous blood.Results:(1) In 25 cases (31 times),90 pair of samples were collected from E and A,and difference in concentration was observed in 86 pairs of samples (95 6%).(2)ICGER was negatively correlated with retention rate of ICG in 15 minutes (ICGR 15 , P <0 001).(3)ICGER was positively correlated with clearance rate of ICG(ICGK, P <0 001).(4)Changes in ICGER were consistent with the liver function.Conclusions:Determination of ICGER by vena cava catheter,the location of which being verified by the characters of intracardiac electrocardiogram,showed that it may serve as a convenient,effective,and accurate method in diagnosis and treatment of liver diseases.