From the Department of Surgery (E.C.D., D.N.H., A.A., E.B.), University of Texas Medical Branch, Galveston, Texas; Metabolism Unit (E.C.D., D.N.H., R.P.M., E.B.), Shriners Hospitals for Children, Galveston, Texas; Department of Surgery (A.A.), University of Texas Medical Branch, Galveston, Texas; Haukeland University Hospital, Bergen, Norway; Department of Pediatrics (E.C.D., M.A.C., E.B.), University of Arkansas for Medical Sciences, Little Rock, Arkansas; Arkansas Children's Nutrition Center (E.C.D., M.A.C., E.B.), Little Rock, Arkansas; and Arkansas Children's Research Institute (E.C.D., M.A.C., E.B.), Little Rock, Arkansas.
J Trauma Acute Care Surg. 2019 May;86(5):817-822. doi: 10.1097/TA.0000000000002180.
Clearance of indocyanine green dye (ICGc) reflects sinusoidal perfusion and hepatocyte cell membrane function. Thus, ICGc is a reflection of the functional reserve of intact hepatocytes. The purpose of this study was to identify predictors of ICGc in severely burned children during the acute hospitalization and at the time of discharge from the intensive care unit (ICU). A secondary aim was to determine the relationship between liver size and patient ICGc.
Twenty-six children (0.8-17 years old) with 35% or greater total body surface area burned (%TBSA-B) were included. Assessment of ICGc (in milliliters per minute per meter squared) was done during the acute hospitalization (median: 6 days after admission, median: 14 days postburn) and at the time of discharge from the ICU (median: 19 days after admission, median: 27 days postburn). Age, TBSA-B, % third-degree burns, inhalation injury, preexisting chronic malnutrition, hematocrit, liver dysfunction, and time from burn injury were incorporated in multiple linear regressions as predictive variables of ICGc. Only variables with p < 0.05 were retained in the final models.
Time from injury and age were the strongest predictors of ICGc during the acute admission but not at the time of discharge from the ICU. Time from injury was negatively associated with ICGc, whereas age was positively associated. At the time of discharge from the ICU, ICGc was increased in proportion to the %TBSA-B, whereas inhalation injury and preexisting chronic malnutrition were associated with lower ICGc. There was no correlation between change-to-predicted liver length and ICGc.
The intrinsic ability of the liver to extract ICG from plasma was lower in younger burned patients during the acute admission and in those with preexisting chronic malnutrition and inhalation injury at the time of discharge from the ICU.
Prognostic/Epidemiologic, level III.
吲哚菁绿染料（ICGc）清除率反映了窦状隙灌注和肝细胞细胞膜功能。因此，ICGc 反映了完整肝细胞的功能储备。本研究旨在确定严重烧伤儿童在急性住院期间和从重症监护病房（ICU）出院时 ICGc 的预测因素。次要目的是确定肝大小与患者 ICGc 之间的关系。
纳入了 26 名（0.8-17 岁）烧伤面积达 35%或以上的儿童（%TBSA-B）。在急性住院期间（中位数：入院后 6 天，中位数：烧伤后 14 天）和从 ICU 出院时（中位数：入院后 19 天，中位数：烧伤后 27 天）评估 ICGc（毫升/分钟/平方米）。年龄、TBSA-B、%三度烧伤、吸入性损伤、预先存在的慢性营养不良、红细胞压积、肝功能障碍和烧伤损伤后的时间被纳入多元线性回归模型中，作为 ICGc 的预测变量。仅保留 p<0.05 的变量进入最终模型。
从损伤到评估的时间和年龄是急性入院期间 ICGc 的最强预测因素，但不是在从 ICU 出院时。从损伤到评估的时间与 ICGc 呈负相关，而年龄与 ICGc 呈正相关。在从 ICU 出院时，ICGc 与 %TBSA-B 成正比增加，而吸入性损伤和预先存在的慢性营养不良与较低的 ICGc 相关。预测肝长度的变化与 ICGc 之间没有相关性。
在急性住院期间，年龄较小的烧伤患者和从 ICU 出院时存在预先存在的慢性营养不良和吸入性损伤的患者，其从血浆中提取 ICG 的肝脏内在能力较低。
预后/流行病学，III 级。
