脉动色素浓度测定法检测有效肝脏血流量对肝病患者的临床意义.doc

脉动色素浓度测定法检测有效肝脏血流量对肝病患者的临床意义 李 昆，冯晓彬，林 恒，郑 平，张玉君，郑树国 （第三军医大学西南医院全军肝胆外科研究所，重庆 400038） 摘 要：目的 介绍一种肝储备功能与肝脏有效血流量（Effective Hepatic Blood Flow，EHBF）检测方法，探讨其临床意义。方法 采用脉动色素浓度测定法（pulse dye densitometry，PDD）和传统的分光光度仪比色法同时检测９２例患者吲哚菁绿（Indocyanine green,ICG）15min滞留率（ICGR15），分析检测结果的相关性；采用ＰＤＤ法检测1181例肝癌、85例门脉高压和120例肝血管瘤患者ICGR15、ICG清除率（K）、全身血容量（BV）、心输出量（CO）及EHBF。结果 PDD测定法检测的ICGR15与分光光度仪比色法的测定结果显著相关（Y=0.789X+2.109，r=0.945，P?0.001）。肝癌和门脉高压患者EHBF较肝血管瘤组显著降低，ICGR15和CO显著升高。ICGR15值小于10%的肝癌患者EHBF平均为1.233（L/min），EHBF随着ICGR15的升高显著降低；60岁以上肝癌患者K值、 CO和EHBF较60岁以下组均显著降低。结论 脉动色素浓度测定法具有无创、实时、便捷等优点，检测的各项数据对评估肝储备功能和EHBF，把握手术方式和范围有一定的参考价值。 关键词:脉动色素浓度测定法；肝储备功能；有效肝脏血流量；吲哚菁绿；肝癌 中图法分类号： 文献标识码：A The clinical significance of measuring effective hepatic blood flow by pulse dye densitometry Li kun Feng xiaobin Lin hen Zheng ping Zhang yujun Zheng shuguo （Hepatobiliary Surgery Institute of PLA, Southwest Hospital, Third Military Medical Univesity,Chongqing 400038） Abstract：Objective To introduce a new method for measuring hepatic reserve function and effective hepatic blood flow (EHBF), and to assess the clinical significance of them in patients with hepatocellular carcinoma. Methods The correlation between indocyanine green 15 minutes retention rate (ICGR15) measured by pulse dye densitometry (PDD) and spectrophotometry was analyzed in 92 patients. 1181 patients with hepatocellular carcinoma (HCC), 85 patients with portal hypertension and 120 patients with hepatic hemangioma were enrolled in this study. ICGR15, plasma dye clearance rate (K),blood volume (BV), cardiac output (CO) and EHBF were monitored by PDD. Results ICGR15 measured spectrophotometrically in vitro in blood samples was significantly correlated with that obtained using PDD method. EHBF obtained from patients with HCC or portal hypertension were obviously lower than those from patients with hepatic hemangiomal, but ICGR15 and CO had the adverse tendency. The mean value of EHBF from patients