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首页> 外文期刊>Critical care : >Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting - an observational study
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Perioperative indocyanine green clearance is predictive for prolonged intensive care unit stay after coronary artery bypass grafting - an observational study

机译：围手术期吲哚菁绿清除率可预测冠状动脉搭桥术后重症监护病房的长期停留-一项观察性研究

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IntroductionDuring cardiac surgery with cardiopulmonary bypass (CPB) haemodilution occurs. Hepatic dysfunction after CPB is a rare, but serious, complication. Clinical data have validated the plasma-disappearance rate of indocyanine green (PDR ICG) as a marker of hepatic function and perfusion. Primary objective of this analysis was to investigate the impact of haemodilutional anaemia on hepatic function and perfusion by the time course of PDR ICG and liver enzymes in elective CABG surgery. Secondary objective was to define predictors of prolonged ICU treatment like decreased PDR ICG after surgery.Methods60 Patients were subjected to normothermic CPB with predefined levels of haemodilution anaemia (haemotacrit (Hct) of 25% versus 20% during CPB). Hepatic function and perfusion was assessed by PDR ICG, plasma levels of aspartate aminotransferase (ASAT) and α-GST. Prolonged ICU treatment was defined as treatment ≥ 48 hours.ResultsLogistic regression analysis showed that all postoperative measurements of PDR ICG (P < 0.01), and the late postoperative ASAT (P < 0.01) measurement were independent risk factors for prolonged ICU treatment. The predictive capacity for prolonged ICU treatment was best of the PDR ICG one hour after admission to the ICU. Furthermore, the time course of PDR ICG as well as ASAT and α-GST did not differ between groups of haemodilutional anaemia.ConclusionsOur study provides evidence that impaired PDR ICG as a marker of hepatic dysfunction and hypoperfusion may be a valid marker of prolonged ICU treatment. Additionally this study provides evidence that haemodilutional anaemia to a Hct of 20% does not impair hepatic function and perfusion.Trial registration[ISRCTN35655335]
机译：简介在进行心脏体外循环（CPB）的心脏手术期间会发生血液稀释。 CPB后的肝功能异常是一种罕见但严重的并发症。临床数据已证实吲哚菁绿（PDR ICG）的血浆消失率可作为肝功能和灌注的标志。该分析的主要目的是研究选择性CABG手术中PDR ICG和肝酶的时程对血稀释性贫血对肝功能和灌注的影响。次要目的是确定延长ICU治疗的预后指标，例如术后PDR ICG降低。方法60患者接受了常温CPB，其血液稀释性贫血的水平达到预定水平（25％，而CPB期间为20％）。通过PDR ICG，血浆天冬氨酸转氨酶（ASAT）和α-GST评估肝功能和灌注。延长ICU治疗定义为治疗≥48小时。结果Logistic回归分析显示，所有术后PDR ICG测量值（P <0.01）和术后晚期ASAT测量值（P <0.01）是延长ICU治疗的独立危险因素。入ICU一小时后，ICU延长治疗的预测能力最佳。此外，两组之间的血液稀释性贫血之间的PDR ICG以及ASAT和α-GST的时程无差异。结论我们的研究提供了证据，即PDR ICG受损是肝功能障碍和灌注不足的标志，可能是长期ICU治疗的有效标志。此外，这项研究提供的证据表明，血液稀释性贫血至Hct为20％不会损害肝功能和灌注。试验注册[ISRCTN35655335]

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