脉搏染料光密度法用于术中直接血容量测定的可行性研究

Feasibility of measuring intraoperative blood volume by pulse dye densitometry

目的研究脉搏染料光密度法(PDD)用于术中直接血容量(BV)测定的可行性。方法 38例ASAⅠ或Ⅱ级择期行骨科手术患者在诱导完成后15min、高容性血液稀释后、出血大于800ml且内固定安放位置合适估计手术不会再有较大出血和补充失血量后静脉注入吲哚菁绿(ICG),同时用PDD及分光光度计检测动脉血中ICG浓度法(ADD)测定BV,比较PDD与ADD的相关性和一致性,并分析影响PDD测定准确性的因素。结果两种方法所测BV的直线相关系数为0.918(P<0.01),BV的差值的均值-204ml,95%CI为(-1124～716)ml。影响PDD的主要因素为ICG的清除率和平均转运时间。结论 PDD可用于肝功能正常、心肺功能正常、ASAⅠ或Ⅱ级的患者术中直接BV的测定。

Objective To assess the feasibility of intraoperative blood volume measurement by pulse dye densitometry（PDD）. Methods Thirty-eight ASA Ⅰ or Ⅱ patients undergoing orthopedic surgeries were enrolled in this study. Blood volume was assessed by indocyanine green （ICG） injection 15 min after anesthesia induction, at the end of acute hypervolemic hemodilution, during bleeding （more than 800 ml） and after transfusion. Blood volume at above time points was calculated independently by PDD and by spectrophotometer dye density diagram （ADD）. The correlation and agreement of results were compared. Factors affecting the accuracy were also analyzed. Results Linear correlation coefficient of the two methods was 0. 918 （P （0.01）, The average difference of blood volume was --0. 204 L[95~CI（--1. 123-0. 715） L]. Clearance rate of ICG and mean transmit time were the main factors affecting the accuracy of PDD. Conclusion PDD is suitable for measuring intraoperative blood volume in ASA 1 or 2 patients with normal liver function and cardio-pulmonary function.