Nishi S, Shindo M, Abe J, Asada A
Department of Anesthesiology and Intensive Care Medicine, Osaka City University Medical School, Osaka, Japan.
Br J Clin Pharmacol. 1998 Jan;45(1):41-7. doi: 10.1046/j.1365-2125.1998.00641.x.
This study was performed to demonstrate that measurement of the clearance of indocyanine green (ICG) following portal vein administration (CLpv) is more useful than that following peripheral vein administration (CLiv) for evaluating intrinsic clearance and hepatic blood flow.
Eight patients, aged 55.9 +/- 8.8 years, who underwent partial hepatectomy were studied. ICG was administrated to all patients via peripheral and portal veins before and after enflurane anaesthesia and soon after surgery. ICG concentrations were measured by h.p.l.c. Non-compartmental analysis was applied to the ICG time-concentration data obtained. The area under the curve (AUC), clearance (CL), mean residence time (MRT) and volume of distribution (V) were calculated using this method of analysis.
CLpv was significantly decreased from 26.4 +/- 13.2 ml kg(-1) min(-1) before anaesthesia, to 19.5 +/- 7.0 (P < 0.05) and 12.7 +/- 5.3 (P < 0.01) ml kg(-1) min(-1), respectively, during anaesthesia and after partial hepatectomy; These values were 72.1% (P < 0.01) and 48.5% (P < 0.01) of that observed at percutaneous transhepatic portography (PTP). CLiv was significantly decreased from 14.6 +/- 5.3 ml kg(-1) min(-1) before anaesthesia, to 9.4 +/- 3.6 (P < 0.05) and 9.8 +/- 4.1 (P < 0.05) ml kg(-1) min(-1), respectively, after partial hepatectomy and 12 h after operation; These values were 68.9% (P < 0.05) and 73.5% (P < 0.05) of the value at PTP. The other pharmacokinetic parameters examined, V and MRT, did not change significantly during anaesthesia or after surgery.
The clearance of ICG after portal administration was useful for estimating hepatic blood flow and intrinsic clearance in perioperative management of liver surgery.
本研究旨在证明，对于评估肝固有清除率和肝血流量，门静脉给药后吲哚菁绿（ICG）清除率（CLpv）的测量比外周静脉给药后（CLiv）更有用。
对8例年龄为55.9±8.8岁、接受部分肝切除术的患者进行研究。在恩氟烷麻醉前后及手术后不久，通过外周静脉和门静脉给所有患者注射ICG。采用高效液相色谱法测定ICG浓度。对获得的ICG时间-浓度数据进行非房室分析。使用该分析方法计算曲线下面积（AUC）、清除率（CL）、平均驻留时间（MRT）和分布容积（V）。
CLpv从麻醉前的26.4±13.2 ml·kg⁻¹·min⁻¹显著降低至麻醉期间的19.5±7.0（P<0.05）和部分肝切除术后的12.7±5.3（P<0.01）ml·kg⁻¹·min⁻¹；这些值分别为经皮经肝门静脉造影术（PTP）时观察值的72.1%（P<0.01）和48.5%（P<0.01）。CLiv从麻醉前的14.6±5.3 ml·kg⁻¹·min⁻¹显著降低至部分肝切除术后的9.4±3.6（P<0.05）和术后12小时的9.8±4.1（P<0.05）ml·kg⁻¹·min⁻¹；这些值分别为PTP时值的68.9%（P<0.05）和73.5%（P<0.05）。所检查的其他药代动力学参数，V和MRT，在麻醉期间或手术后无显著变化。
门静脉给药后ICG的清除率有助于估计肝血流和肝固有清除率，用于肝脏手术围手术期管理。
