Sander Michael, Spies Claudia D, Foer Achim, Syn Doh-Yung, Grubitzsch Herko, Von Heymann Christian
Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
Cardiovasc J Afr. 2007 Nov-Dec;18(6):375-9.
Splanchnic ischaemia and hepatic dysfunction are severe complications after coronary artery bypass grafting (CABG) and lead to increased morbidity and mortality. Non-invasive determination of the indocyanine green (ICG) plasma disappearance rate (PDR) offers an opportunity for the early diagnosis of hepato-splanchnic hypoperfusion. The aim of this study was to establish the postoperative time course of the ICG PDR in elective uncomplicated CABG surgery. After ethical approval and written informed consent, the data of 40 patients were analysed during this prospective study. Measurements of the ICG PDR and cardiac index (CI) in 40 patients undergoing elective CABG surgery were performed immediately after induction of anaesthesia, on admission to the ICU, six hours after admission to the ICU, and on the first postoperative day. Prior to surgery, baseline ICG PDR was 17.7 %/min (13.6-20.4) and baseline CI was 2.2 l/min/m(2) (1.9-2.4). All measurements after surgery showed a significantly higher PDR and cardiac index compared to the baseline measurements. The only patient with prolonged ICU treatment failed to show this increase in ICG PDR, although the CI did increase after surgery. We established normal values of ICG PDR after uncomplicated CABG surgery. The elevated ICG PDR observed in our patients was assumed to be an effect of an increased hepato-splanchnic blood flow due to an increase in the CI. Patients at risk of hepato-splanchnic hypoperfusion, displaying a missed increase or even a decrease in their ICG PDR after surgery might be at risk of hepatic hypoperfusion and in these selected patients the ICG PDR could serve as a tool to guide therapy or to select patients who might benefit from more invasive devices to monitor hepatosplanchnic perfusion and function.
内脏缺血和肝功能障碍是冠状动脉旁路移植术（CABG）后的严重并发症，会导致发病率和死亡率增加。非侵入性测定吲哚菁绿（ICG）血浆消失率（PDR）为肝内脏低灌注的早期诊断提供了机会。本研究的目的是确定择期无并发症CABG手术中ICG PDR的术后时间进程。在获得伦理批准和书面知情同意后，对40例患者的数据进行了这项前瞻性研究分析。对40例行择期CABG手术的患者，在麻醉诱导后、入住重症监护病房（ICU）时、入住ICU 6小时后以及术后第一天，分别测量ICG PDR和心脏指数（CI）。术前，基线ICG PDR为17.7%/分钟（13.6 - 20.4），基线CI为2.2升/分钟/平方米（1.9 - 2.4）。术后所有测量结果显示，与基线测量相比，PDR和心脏指数均显著升高。唯一一名接受延长ICU治疗的患者未显示ICG PDR的这种升高，尽管术后CI确实有所增加。我们确定了无并发症CABG手术后ICG PDR的正常值。我们的患者中观察到的ICG PDR升高被认为是由于CI增加导致肝内脏血流增加的结果。有肝内脏低灌注风险的患者，术后ICG PDR未出现升高甚至下降，可能存在肝低灌注风险，在这些特定患者中，ICG PDR可作为指导治疗或选择可能从更具侵入性的设备监测肝内脏灌注和功能中获益的患者的工具。
