脉动色素浓度测定法行吲哚氰绿清除试验检测肝储备功能指导肝癌治疗方案的选择

目的:初步探讨以肝储备功能为基础选择原发性肝癌合理的治疗方式,提出肝癌整体治疗的策略.方法:41例原发性肝癌患者以脉动色素浓度测定法行吲哚氰绿清除试验检测肝储备功能,结合ChildPugh分级、肿瘤的局部情况等进行综合评估,提出肝癌治疗的个体化方案.对肝切除手术的患者进行术中、术后监测和评价.结果:32例患者接受剖腹手术治疗,其中30例行肝切除术,2例行开腹射频消融术;3例行经皮射频消融术,4例行经导管动脉化疗栓塞,2例等待行肝移植手术.肝切除手术均获得成功,平均手术时间为(207±61)min,术中平均出血量为(489.29±385.47)mL,仅3例患者需要术中输血,手术切缘阴性率100%;全组无手术死亡,共11例患者出现手术并发症,发生率为36.7%,所有并发症经保守治疗后均痊愈;平均住院时间为(27±8)d.结论:以肝储备功能为基础结合Child-Pugh评分、肿瘤局部情况综合评估选择肝癌的个体化治疗方式实用可行,可使肝癌的治疗更为规范.     

吲哚氰绿清除试验在肝硬化患者全凭静脉麻醉术前肝储备功能评估中的应用

目的:评价吲哚氰绿(ICG)清除试验作为肝硬化患者全凭静脉麻醉术前肝储备功能评估的可行性和可靠性、准确性.方法:选择42例择期腹部非肝脏手术的肝硬化患者,肝脏功能Child-Pugh A、B级,ICGR15 0 ～ 10%为A组(n=21),ICGR15 ＞ 10%为B组(n=21).术前进行ICG清除试验,麻醉诱导TCI丙泊酚血浆靶浓度设为3μg/mL,同时输注瑞芬太尼血浆靶浓度4 ng/mL,根据BIS值的变化(40 ～ 60)调整维持麻醉的靶控浓度.结果:在麻醉恢复期,虽然两组患者丙泊酚TCI停止时预期清醒的时间差异无显著性(P ＞ 0.05),但是B组较A组拔出导管时间明显延长, OAA/S评分减低,差异具有极显著性(P ＜ 0.01).结论:ICG清除试验是检测肝储备功能实用可行的理想方法.ICGR15能很好地反映肝硬化患者的肝储备功能,对麻醉恢复情况有良好的预计性.     

吲哚氰绿试验联合血栓弹力图补充Child-Pugh分级在评估门脉高压手术患者肝储备功能中的应用

目的:探讨以吲哚氰绿试验(ICG measurement)和血栓弹力图(TEG)补充Child-Pugh分级所形成的新的肝储备评分系统(Ditan 分级)在评估肝硬化门静脉高压症患者肝储备功能中的可行性.方法:对2006年10月至2009年10月间91例肝硬化门静脉高压症接受联合断流术病例,分别于术前和术后以Child-Pugh与Ditan评分系统评估肝储备功能,了解两种方法预测术后肝功能代偿情况的准确率.结果:Child-Pugh分级法和Ditan分级法预测术后肝功能代偿良好准确率分别为57.89%和89.29%(P<0.05);Child-Pugh分级法和Ditan分级法预测术后肝功能代偿轻度不良准确率分别为68.66%和86.21%(P<0.05).结论:Ditan分级系统较Child-Pugh评分能够更全面评价肝硬化门静脉高压症患者围手术期肝储备功能.     

吲哚氰绿排泄试验在肝脏储备功能评估中的作用

肝脏具有复杂的代谢功能和强大的代偿能力。对肝脏功能损害程度和储备功能的判断，一直是人们关注的热点。术前肝储备功能的正确评估，对肝硬化．特别是肝癌肝叶切除术患者在外科临床更显重要。肝功能衰竭是肝癌切除术后严重的并发症，也是导致术后死亡的主要原因。肝功能衰竭的发生．主要与肝硬化引起的肝脏储备功能下降有关，也与手术过程，包括切除肝脏体积、术中出血、阻断肝门血流与否以及围手术期的处理等有关。术前正确评估肝脏储备功能，术中合理掌握切肝量，是避免术后肝功能衰竭的重要措施。     

肝储备功能测定在门静脉高压症手术患者中的临床应用价值

目的探讨肝储备功能测定在门静脉高压症手术患者中的临床应用价值。方法 43例肝硬化门静脉高压症患者术前测定吲哚氰绿(ICG)15min潴留率(ICGR15),并根据结果将患者分为3组,同时对所有患者进行Child-Pugh评分。根据联合断流术后患者肝脏损伤程度及恢复情况将患者分为轻度损伤(M)组和重度损伤(S)组。分析两组术前ICGR15的差异。结果联合断流术后M组与S组术前ICGR15差异有统计学意义[(11.3±6.2)%vs.(27.1±6.4)%,P<0.05]。结论 ICGR15能更准确地评估患者肝储备功能,其临床应用有助于降低门静脉高压症患者手术并发症的发生,降低死亡率。     

肝衰竭患者肝储备功能检测的护理

总结应用肝脏储备功能分析系统检测肝衰竭患者肝储备功能的护理。护理重点是检测前做好心理护理,完善检测准备工作,检测时合理安置鼻探头,准确推注药物,密切观察不良反应的发生,保证检测顺利完成。     

DDG-3300K肝储备功能分析仪在肝胆外科的应用与护理

[目的]探讨DDG-3300K肝储备功能分析仪在肝胆外科的临床应用与护理效果。[方法]利用DDG-3300K肝脏储备功能分析仪对102例肝癌病人进行吲哚氰绿15 min潴留率的检测,检测前进行健康教育,检测中关注病人的感受并积极配合,检测后严密观察病人有无不良反应。[结果]101例首次检测成功;1例失败,间隔40 min后,再次检测成功。[结论]应用DDG-3300K肝储备功能分析仪进行肝储备功能检测具有无创、快捷、方便、实用、精确等优点,正确规范的护理操作方法能保证检测结果的准确性。     

肝储备功能分析仪的应用与护理

目的探讨肝储备功能分析仪（dye densito-graph analyzer,DDG分析仪）的应用及护理。方珐采用DDG分析仪对566例患者进行吲哚氰绿15min潴留率的检测,并加强操作前、中、后的护理。结果545例（96．3％）患者顺利完成检测;仅有3例（0．5％）出现不良反应。结论应用DDG分析仪进行肝储备功能检测具有安全、方便、微创的优点,正确的护理操作能保证检测的顺利完成和结果的准确性。     

吲哚菁绿清除试验在肝癌治疗中的应用进展

肝癌是一种严重威胁人类健康的疾病,肝癌治疗前需要进行肝储备功能评估,但由于肝结构与功能的复杂性,目前尚无可全面评估肝功能的方法,吲哚菁绿清除试验作为一种能够动态地、迅速地评估肝储备功能的方法被广泛应用于肝癌治疗中肝储备功能评估。本文分析归纳了吲哚菁绿清除试验在肝癌治疗肝储备功能评估中的应用,得出吲哚青绿清除试验在肝癌治疗尤其在肝切除术时能够准确评估肝储备功能,预测术后肝功能不全。     

吲哚菁绿清除试验评估肝功能储备的观察与护理

吲哚菁绿清除试验为侵入性操作,患者对暗绿色药液普遍有畏惧心理,进行吲哚菁绿试验前,掌握吲哚菁绿的性能、剂量、用法、注意事项。试验过程中密切观察患者的反应并及时采取有效的应对措施。检测前备好急救药品和器材。     

Perioperative monitoring of circulating and central blood volume in cardiac surgery by pulse dye densitometry

OBJECTIVE: To determine perioperative changes in circulating (BVI) and central blood volume (CBVI) by a new dye dilution technique using pulse dye densitometry. DESIGN AND SETTING: Prospective observational study in the cardiac anesthesia and intensive care unit of a university hospital. PATIENTS: Sixty-six patients undergoing coronary artery bypass surgery. MEASUREMENTS AND RESULTS: Hemodynamic measurements by the dye dilution method using pulse dye densitometry were performed prior to skin incision and 3.3+/-1.4 h and 17+/-2.7 h after surgery. Based on conventional monitoring the therapeutic goals of hemodynamic therapy were achieved in all of the patients of this study. Despite a marked positive fluid balance which developed during surgery mean BVI decreased significantly after surgery while CBVI remained unchanged. Postoperative BVI deficits vs. preoperative values were observed in 78% of patients; these BVI deficits were profound in 29% of the cases. In contrast, 65% of the individual patients showed no or only minor postoperative changes in CBVI vs. preoperative values. CONCLUSIONS: Changes in the intravascular volume compartments affected BVI to a greater extent than CBVI. Therefore measuring circulating in addition to central blood volume may be useful to ensure a normal circulating blood volume that can compensate for any change in the central vascular compartment.     

Methodological limitations of the use of intrinsic hepatic clearance of ICG as a measure of liver cell function

Abstract Negligible extra-hepatic elimination of indocyanine green (ICG) makes it well suited as a liver test substance. The liver blood flow rate ( Q ) is estimated from concentration measurements in peripheral ( A ) and hepatic venous ( V ) blood during a constant ICG infusion rate (Inf), as Q = Inf/( A – V ). Intrinsic hepatic clearance of ICG, Cli = Inf/((A – V)/In( A/V )), is interesting because it should give a flow-independent quantitative estimate of liver cell function, utilizing the same concentration measurements. The present study was aimed to investigate possible limitations involved in the estimation and use of Cli of ICG in 41 liver patients and 20 controls. Time-dependence was studied by means of two successive 40-min infusion periods (with no significant change in Q ). Cli of ICG decreased 6% per hour ± 3% (mean ± SD, n = 6, P < 0·01) due to a small but significant increase of the concentrations during the infusion period. Flow-dependence was studied by measurements before and after an increment of flow of on average 51%, induced by the intake of a meal. This caused no significant change in Cli of ICG ( P > 0·5, n = 5, Student's paired t -test). The intrinsic hepatic clearance of ICG was on average 0·75 ± 0·26 1 plasma min^-1 (± SD, n = 20) in controls and 0·39 ± 0·18 1 plasma min^-1 in liver patients ( n = 41), P < 0·001. It was positively correlated to the galactose elimination capacity, although the scatter was large ( P < 0·05, n = 56). This might be due to the fact that Cli depends both on liver cell function and on intra-hepatic vascular shunting of blood.     

CT灌注成像与CTP评分在肝硬化肝储备功能评估中的相关性

目的探讨Child-Turcotte-Pugh(CTP)评分与CT灌注成像在肝硬化患者肝储备功能评估中的相关性及其临床意义。方法选择30例肝硬化患者(肝硬化组)及30例健康对照者(对照组),进行CTP评分,并行多层螺旋CT灌注扫描,计算灌注参数:门静脉灌注量(HPP)、肝动脉灌注量(HAP)、总肝灌注量(TLP)和肝动脉灌注指数(HPI),评价肝硬化患者的CT灌注成像各项参数与CTP评分之间的相关性。结果肝硬化组与对照组比较,HPP〔(0.4958±0.2313)vs(0.9356±0.2679)ml/min·ml,P=0.000〕、TLP〔(0.8437±0.3242)vs(1.1326±0.3720)ml/min·ml,P=0.022〕均降低,差异有统计学意义。肝硬化组CTP评分与HPP(r=-0.793,P=0.000)、与TLP(r=-0.815,P=0.021)均呈负相关。结论与CTP评分体系相比,CT灌注参数可反映肝硬化患者肝脏的血流灌注情况,对肝储备功能评估有一定指导作用。     

Effects of transjugular intrahepatic portosystemic shunt using the Viatorr stent on hepatic reserve function in patients with cirrhosis

BACKGROUNDAs transjugular intrahepatic portosystemic shunt (TIPS) creation alters the hemodynamic status of the portal system, whether reduced portal blood supply affects the synthetic reserve function of the liver has been the focus of clinical attention. Since the Viatorr stent entered the Chinese market in 2015, it has not yet been widely used in clinical practice. Further, unlike other countries, the main cause of liver cirrhosis in China is viral hepatitis. Therefore, use of the Viatorr stent to establish a TIPS channel in patients with liver cirrhosis with differing etiologies is of great clinical interest.AIMTo investigate factors affecting changes in liver reserve function after TIPS Viatorr stent implantation.METHODSClinical data from 200 patients with cirrhotic portal hypertension who received TIPS treatment from March 2016 to March 2020 were analyzed retrospectively. The patients were divided into three groups (A-C), according to their disease etiology, with post-hepatitis, autoimmune, and alcoholic cirrhosis, respectively. Preoperative and postoperative liver and renal function and coagulation data, Child-Pugh grade, and model for end-stage liver disease (MELD) scores were collected. Statistical analyses were performed using the t-test or chi-square test. The incidence and of hepatic encephalopathy and patient survival were calculated using Kaplan-Meier method.RESULTSThe surgical success rate was 100%, with mean portal pressure gradient (mmHg) decreasing from 25.5 ± 5.22 to 10.04 ± 2.76 (t = 45.80; P < 0.001). After 24 mo, the cumulative incidence of hepatic encephalopathy in group A was significantly lower than that in group B/C, while the cumulative survival rate was significantly higher in group A than in group B/C (P < 0.05 for both). The Child-Pugh score for group A was 6.96 ± 1.21, which was significantly better than those of groups B (7.42 ± 0.99; t = -2.44; P = 0.016) and C (7.52 ± 1.12; t = -2.67; P = 0.009). Further, the MELD score for group A (9.62 ± 2.19) was significantly better than those for groups B (10.64 ± 1.90; t = -2.92; P = 0.004) and C (10.82 ± 2.01; t = -3.29; P = 0.001).CONCLUSIONInsertion of 8 mm internal diameter Viatorr stent has no significant effects on liver reserve function. Changes of liver reserve function in the medium and long term may be related to the etiology and treatment of portal hypertension.     

血清胱抑素C联合尿微量清蛋白检测在诊断高血压早期肾功能损害中的价值

目的：分析血清胱抑素C（Cys C）联合尿微量清蛋白（mALB）检测在高血压早期肾功能损害中的诊断价值。方法选择2012年1月至2013年12月南京市中西医结合医院320例患者为研究对象,其中高血压组130例,肾功能损害组90例,健康对照组100例。检测每组mALB、肌酐（Scr）、尿素氮（BUN）、Cys C水平,并比较每组Scr、BUN及mALB联合Cys C检测对早期肾功能损害的检出率。结果高血压组mALB、Cys C水平,肾功能损害组mALB、Scr、BUN、Cys C水平均明显高于健康对照组,差异均有统计学意义（P＜0．05）。高血压组Scr、BUN对早期肾功能损害检出率为13．8％、14．6％,均明显低于 mALB联合Cys C （32．3％）,差异均有统计学意（P＜0．05）;肾功能损害组 Scr、BUN 对早期肾功能损害检出率均为53．3％,mALB 联合 Cys C 检出率则为100．0％,差异均有统计学意（P＜0．05）。结论 Cys C联合mALB检测可显著提高高血压早期肾功能损害的检出率,值得临床推广应用。     

超声造影对肝脏肿瘤良恶性鉴别诊断的临床应用

目的探讨应用SonoVue进行超声造影对比常规超声在提高肝脏肿瘤良恶性鉴别诊断的应用价值。方法回顾分析78例常规超声检出肝脏局灶性病变（FLL）,根据二维及彩色多普勒特点,结合病史给出初步良恶性判断后,进一步采用超声造影,对病灶造影剂灌注过程进行分析,得出修正判断;最后以病理结果为金标准,进行统计学分析。结果78个病灶中病理结果示良性病灶32例,恶性病灶46例。超声造影在良恶性鉴别诊断的敏感性为92.8%,特异性为91.7%,准确性92.3%,明显优于常规超声。结论应用静脉团注SonoVue法进行实时灰阶超声造影有助于肝局灶性病变良恶性的鉴别诊断。