Department of Anesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
Anesth Analg. 2010 Feb 1;110(2):466-72. doi: 10.1213/ANE.0b013e3181c92b09.
Indocyanine green plasma disappearance rate (ICG-PDR) is used to evaluate hepatic function. Although hepatic failure is generally said to occur with an ICG-PDR <18%/min, ICG disappearance rate is poorly defined in the healthy population, and a clear cutoff value of ICG-PDR that discriminates between normal hepatic function and hepatic failure has not yet been described. We therefore defined the ICG disappearance rate in an otherwise healthy patient population. In addition, we evaluated the noninvasive measurement of ICG-PDR (transcutaneously by pulse dye densitometry [PDD] at the finger and the nose) and compared these with the simultaneously performed invasive measurements of ICG-PDR (in arterial blood).
In patients without signs of liver disease, scheduled for elective nonhepatic surgery, 10 mg ICG was administered IV and ICG-PDR measured by PDD (DDG-2001, Nihon Kohden, Tokyo, Japan). In a subset of patients, arterial blood samples were gathered to compare PDD with invasive ICG measurements. Methods were compared using Bland-Altman analysis. The results of our study and reported studies on discriminative use of ICG-PDR in assessing liver failure were used to construct receiver operating characteristic curves.
Forty-one patients were studied: 33 using the finger probe and 8 using the nose probe. The mean +/- SD noninvasive ICG-PDR in this patient population is 23.1% +/- 7.9%/min (n = 41) with a range of 9.7% to 43.2%/min. Bias (+/-2 sd, limits of agreement) for ICG-PDR measured by PDD compared with those measured in arterial blood were 1.6%/min (-5.2% to 8.3%/min) for the finger probe and -6.0%/min (-15.5% to 3.4%/min) for the nose probe.
ICG-PDR values in a population without liver failure ranged well below 18%/min, cited as the cutoff value for hepatic failure. This cutoff value needs reconsideration. In addition, we conclude that the ICG concentration is adequately determined noninvasively by PDD.
吲哚菁绿血浆清除率（ICG-PDR）用于评估肝功能。尽管通常认为 ICG-PDR <18%/min 时会发生肝衰竭，但健康人群中 ICG 清除率的定义并不明确，也尚未描述区分正常肝功能和肝衰竭的 ICG-PDR 明确截断值。因此，我们在健康人群中定义了 ICG 清除率。此外，我们评估了 ICG-PDR 的非侵入性测量（通过手指和鼻子处的脉冲染料密度测定法 [PDD] 经皮测量），并将其与同时进行的 ICG-PDR 侵入性测量（动脉血样）进行了比较。
在无肝病史、拟行择期非肝手术的患者中，静脉内给予 10mg ICG，并通过 PDD（日本光电工业株式会社，东京）测量 ICG-PDR。在部分患者中，采集动脉血样以比较 PDD 与侵入性 ICG 测量结果。采用 Bland-Altman 分析比较方法。使用本研究结果和报道的关于 ICG-PDR 在评估肝衰竭中的判别应用的研究结果构建受试者工作特征曲线。
共研究了 41 例患者：33 例使用手指探头，8 例使用鼻探头。该患者人群的非侵入性 ICG-PDR 平均值为 23.1% +/- 7.9%/min（n = 41），范围为 9.7%至 43.2%/min。与动脉血样相比，PDD 测量的 ICG-PDR 的偏倚（+/-2sd，一致性界限）为手指探头时为 1.6%/min（-5.2%至 8.3%/min），鼻探头时为-6.0%/min（-15.5%至 3.4%/min）。
无肝衰竭的人群中 ICG-PDR 值明显低于 18%/min，这被认为是肝衰竭的截断值。这一分界值需要重新考虑。此外，我们得出结论，通过 PDD 可以非侵入性地充分确定 ICG 浓度。
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