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Indozyaningrün-Plasmaverschwinderate

Marker einer partiellen Ischämie im Hepatosplanchnikustrakt

Indocyanine green plasma disappearance rate

Marker of partial hepato-splanchnic ischemia

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Zusammenfassung

Der Farbstoff Indozyaningrün (ICG) wird nahezu ausschließlich von der Leber eliminiert und die Indozyaningrün-Plasmaverschwinderate („indocyanine green plasma disappearance rate“, ICG-PDR) dient daher zur klinischen Erfassung der Leberdurchblutung und -zellfunktion. Die ICG-PDR, die heutzutage mithilfe eines transkutanen Systems nichtinvasiv gemessen werden kann, ermöglicht das bettseitige und zeitnahe regionale Monitoring bei kritisch kranken Patienten. Bislang wurde klinisch nur der völlige Ausfall der ICG-Elimination als ein Zeichen einer komplett fehlenden Leberdurchblutung (A. hepatica und V. portae) im Rahmen einer Lebertransplantation publiziert. In dieser Kasuistik werden zwei Patienten beschrieben, bei denen es zu einer partiellen Hepatosplanchnikusischämie mit nichtadäquat angestiegener ICG-PDR nach Revaskularisierung bzw. einem akuten Abfall der ICG-PDR kam. Die in beiden Fällen eingeleitete bildgebende Diagnostik (Angiographie, Computertomographie) bestätigte die mithilfe der ICG-PDR gestellte Verdachtsdiagnose einer akuten abdominellen Ischämie. In beiden Fällen zeigte sich ein Verschluss des Truncus coeliacus bei erhaltener Durchblutung über die A. mesenterica superior bzw. die V. portae. Die ICG-PDR kann einen frühzeitigen Hinweis auf eine Ischämie im Hepatosplanchnikustrakt geben, und sie ermöglicht somit die rasche Einleitung weiterführender Untersuchungen zur Diagnosesicherung.

Abstract

Indocyanine green (ICG) is nearly exclusively eliminated from the blood by the liver and the ICG plasma disappearance rate (ICG-PDR) enables assessment of liver blood flow and function. The ICG-PDR which nowadays can be measured non-invasively by a transcutaneous system enables bedside and “on-line” regional monitoring in critically ill patients. So far, only complete lack of ICG-PDR as a sign of non-existing perfusion during liver transplantation has been reported. We describe two patients who developed mesenteric ischemia accompanied by an inadequate increase after revascularisation and an acute drop in the ICG-PDR. In both cases, a computed tomography scan was performed and confirmed an acute abdominal ischemia as indicated by ICG-PDR. Both patients suffered from occlusion of the truncus coeliacus while hepato-splanchnic perfusion via the A. mesenterica superior and the V. portae was maintained. ICG-PDR may be helpful for early detection of hepato-splanchnic ischemia and enables rapid and sufficient initiation of diagnostic and therapeutic procedures. In conclusion, ICG-PDR may be regarded as a clinically attractive bedside monitoring tool for early and reliable detection of partial ischemia in the hepato-splanchnic tract.

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Interessenkonflikt

Dr. Samir Sakka hat für wissenschaftliche Vorträge Honorarzahlungen von der Fa. Pulsion Medical Systems AG, München, erhalten.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena, Jena, Deutschland

    O. Thümer

  2. Klinik für Anästhesie und Intensivmedizin, Klinikum Worms, Worms, Deutschland

    E. Hüttemann

  3. Klinik für Anästhesiologie und operative Intensivmedizin, Krankenhaus Köln-Merheim, Ostmerheimer Str. 200, 51109, Köln, Deutschland

    S.G. Sakka DEAA, EDIC

Authors
  1. O. Thümer
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  2. E. Hüttemann
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  3. S.G. Sakka DEAA, EDIC
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Correspondence to S.G. Sakka DEAA, EDIC.

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Thümer, O., Hüttemann, E. & Sakka, S. Indozyaningrün-Plasmaverschwinderate. Anaesthesist 56, 339–344 (2007). https://doi.org/10.1007/s00101-007-1146-4

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  • DOI: https://doi.org/10.1007/s00101-007-1146-4

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