采用 LIMON 评估丙泊酚和右美托咪定对早期感染性休克患者吲哚菁绿清除率的影响：一项初步研究。

Effects of propofol and dexmedetomidine on indocyanine green elimination assessed with LIMON to patients with early septic shock: a pilot study.

机构信息

Medical Faculty, Department of Anaesthesiology and Reanimation, Trakya University, Edirne 22030, Turkey.

出版信息

J Crit Care. 2009 Dec;24(4):603-8. doi: 10.1016/j.jcrc.2008.10.005.

DOI:10.1016/j.jcrc.2008.10.005

PMID:19931154

Abstract

BACKGROUND

We aimed to select the sedative drug with the least impact on hepatic blood flow in sedation-administered patients. In our study, we aimed to establish whether dexmedetomidine and propofol affect liver function during early septic shock. The hepatic blood flow is evaluated by the transcutaneous assessment of indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients.

METHODS

Forty early septic shock patients were included in the study and administered either the loading dose infusion of propofol (n = 20, group P) of 1 mg/kg over 15 minutes followed by a maintenance dose of 1 to 3 mg/kg per hour (n = 20, group P), or a loading dose of dexmedetomidine 1 microg/kg over 10 minutes followed by a maintenance of 0.2 to 2.5 microgg/kg per hour (n = 20, group D) (24-hour infusion). Indocyanine green (ICG) elimination tests were conducted concurrently using the noninvasive liver function monitoring system (LiMON; Pulsion Medical Systems, Munich, Germany). A dose of 0.3 mg/kg of ICG was given through a cubital fossa vein as a bolus and immediately flushed with 10 mL of normal saline. We calculated ICG-PDR. Indocyanine green plasma disappearance rate measurements were obtained at baseline (before start of the propofol or dexmedetomidine infusion) and were repeated at the 24th hour. Biochemical and hemodynamic parameters and ICG-PDR were recorded before start of the study and at 24th hour.

RESULTS

Biochemical and hemodynamic parameters did not differ significantly between the groups (P < .05). Baseline ICG-PDR levels of group P compared to group D were 24.7 +/- 14.4 vs 22.2 +/- 10.7, respectively, and after the study, ICG-PDR levels (26.5 +/- 13.7 vs 23.7 +/- 12.4) did not differ in groups (P > .05). When we examined ICG-PDR changes between groups before and after administration, there was no significant difference (P > .05).

CONCLUSION

In our study, we found that neither propofol nor dexmedetomidine infusion affected hepatic blood flow.

摘要

背景

我们旨在选择在镇静治疗患者中对肝血流影响最小的镇静药物。在我们的研究中，我们旨在确定右美托咪定和丙泊酚是否会在早期感染性休克期间影响肝功能。通过经皮评估吲哚菁绿（ICG）血浆消除率（ICG-PDR）来评估肝血流量，这一方法在危重病患者中得到了应用。

方法

本研究纳入了 40 例早期感染性休克患者，分别给予丙泊酚负荷剂量输注（n = 20，P 组），即 15 分钟内输注 1 mg/kg，然后以 1 至 3 mg/kg/小时的维持剂量输注（n = 20，P 组），或给予右美托咪定负荷剂量 1 μg/kg 静脉推注 10 分钟，然后以 0.2 至 2.5 μg/kg/小时的维持剂量输注（n = 20，D 组）（24 小时输注）。同时使用非侵入性肝功能监测系统（LiMON；Pulsion Medical Systems，慕尼黑，德国）进行 ICG 消除试验。通过肘窝静脉给予 0.3 mg/kg 的 ICG 作为推注，并立即用 10 mL 生理盐水冲洗。我们计算 ICG-PDR。在开始丙泊酚或右美托咪定输注之前（基础状态）和 24 小时时分别测量 ICG-PDR。在研究开始前和 24 小时时记录生化和血流动力学参数以及 ICG-PDR。

结果

两组的生化和血流动力学参数无显著差异（P <.05）。与 D 组相比，P 组的基础 ICG-PDR 水平分别为 24.7 ± 14.4 对 22.2 ± 10.7，研究结束后，两组的 ICG-PDR 水平（26.5 ± 13.7 对 23.7 ± 12.4）无差异（P >.05）。当我们检查两组给药前后 ICG-PDR 的变化时，差异无统计学意义（P >.05）。