Möhnle P, Kilger E, Adnan L, Beiras-Fernandez A, Vicol C, Weis F
Department of Anesthesiology, Ludwig-Maximilians-University of Munich, Munich, Germany.
Perfusion. 2012 Jul;27(4):292-9. doi: 10.1177/0267659112439596. Epub 2012 Feb 21.
Plasma clearance of indocyanine green has recently been established as a tool to monitor hepatic function and perfusion non-invasively. Reduced indocyanine green clearance has been associated with adverse outcome in cardiac surgery patients, and cardiopulmonary bypass has been hypothesized to be one important triggering factor. We performed a prospective observational study comparing the influence of off-pump and on-pump coronary surgery on perioperative indocyanine green clearance. Twenty-five consecutive adult patients without known pre-existing hepatic diseases scheduled for off-pump coronary artery bypass grafting were evaluated for hepatic dysfunction pre- and postoperatively with serial measurements of indocyanine green plasma clearance, specific laboratory values and liver function scores. Twenty-five matched patients who underwent coronary artery bypass grafting surgery with cardiopulmonary bypass in the same period served as controls. Parameters of postoperative hepatic function, including measurements of indocyanine green plasma clearance and specific laboratory values and scores, did not differ significantly between patients undergoing off-pump coronary artery bypass grafting and patients undergoing coronary artery bypass grafting with extracorporeal circulation. In patients without pre-existing hepatic diseases, a significant influence of cardiopulmonary bypass on perioperative indocyanine green plasma clearance as well as on liver specific laboratory parameters and scores cannot be proven.
最近，吲哚菁绿的血浆清除率已被确立为一种无创监测肝功能和灌注的工具。吲哚菁绿清除率降低与心脏手术患者的不良预后相关，体外循环被认为是一个重要的触发因素。我们进行了一项前瞻性观察性研究，比较非体外循环和体外循环冠状动脉手术对围手术期吲哚菁绿清除率的影响。对连续25例计划进行非体外循环冠状动脉搭桥术且无已知既往肝病的成年患者，通过连续测量吲哚菁绿血浆清除率、特定实验室值和肝功能评分，对其术前和术后的肝功能障碍进行评估。同期25例接受体外循环冠状动脉搭桥术的匹配患者作为对照。非体外循环冠状动脉搭桥术患者和体外循环冠状动脉搭桥术患者术后肝功能参数，包括吲哚菁绿血浆清除率测量值、特定实验室值和评分，差异无统计学意义。在无既往肝病的患者中，无法证明体外循环对围手术期吲哚菁绿血浆清除率以及肝脏特定实验室参数和评分有显著影响。
