PERIOPERATIVE HEMODYNAMIC CHANGES INADULT LIVING DONOR LIVER TRANSPLANTATION

可用于衡量心脏输出、指数（CI）、级联功能和血液体积。We used ICG to evaluate the effect of living donor liver transplantation （LDLT） for patients of end-stage liver diseases （ESLD） on perioperative hemodynamic changes and renal functions。患者和方法： ICG测试在周期性阶段进行了20次成人LDLT测试。Futhermore、examinations and were performed preoperative、immediate after LDLT （day 0）、postoperative day （POD） 1、2、3、7、10、14、21 and 28。ICG边缘化试验是用光谱测定法和非侵入性手指或鼻子碎片法进行的。和renal功能测试包括血清和胰岛素β 2微球蛋白（BMG）、钠（FENa）的分形提取、24小时的creatine清除值（CCr）、血清creatine值（Cr）、N-乙酰-β-D-葡萄糖胺酶（NAG）值在同一时间测量。结果： CI在LDLT之前在POD 10之前显著高于（4.303 a 1.294 vs 3.165±0.999 1/min/m^2： P<.05） ... More .在POD 14之后， CI在预LDLT和正常化之间没有显著差异（POD 14： 3.136±1.092， CI正常范围3- 41/min/m^2）。如预期的异常功能测试，在疾病第14天前比较每个因素，如CCr下降75.9± 34.2 （毫升/分钟）至46.1±19.6。NAG shows 17. 6 ± 12. 1（U/ to 14. 0 ± 11. 6， it means the prox\tubule disorder。作为尿BMG显示729.9 ±2012.5 （μg/I）至939.21±431.3，这意味着renal tubule和glomerulus disorder。FENA shows 1. 2 ± 1. 1（%） to 1. 0 ± 0. 7， it does not show a change。Cr shows 1. 2 ± 1. 1（mg/dl） to 0. 7 ± 0. 3， as for Cr， it improved.Conclusion： The Management teristic of hemodynamics in ESLD patients is extremely large cardiac output， so-called hyperdynamic state。在这项研究中， CI在LDLT之前比POD 10高得多。因此，我们认为，在LDLT后，超动态阶段将继续进行最少10天。LDLT的Cr值也得到了改进，现有专利登记障碍，NAG和BMG值提升的例子。也有这样的想法，因为ICG测试是一种非常有用的评估方法，用于ESLD患者对周期性管理的循环变化，以及循环变化的改进，这并不意味着对renal函数的改进。因此，我们应该考虑当我们想到LDLT患者的renal功能时，除了改变电路的因素。Less（低）

Indocyanine green (ICG) can be used to measure cardiac output, index (CI), hepatic function, and blood volume. We used ICG to evaluate the effect of living donor liver transplantation (LDLT) for patients of end-stage liver diseases (ESLD) on perioperative hemodynamic changes and renal functions. Patient and Method: ICG examination was performed 20 adult LDLT in perioperative stage. Futhermore, examinations and were performed preoperative, immediate after LDLT (day 0), postoperative day (POD) 1, 2, 3, 7, 10, 14, 21 and 28. ICG elimination test was performed by spectrophotometric method and a noninvasive finger or nose-piece method. And renal function test including serum and urineβ2- microglobulin (BMG), fractional excretion of sodium (FENa), 24 hours creatinine clearance value(CCr), serum creatinine value(Cr), N-acetyl-β-D-glucosaminidase(NAG) value were measured at same time.Result: CI was significantly higher until POD 10 than before LDLT (4.303ア1.294 vs 3.165±0.999 1/min/m^2: P<.05) … More . After POD 14, CI was not significantly different between preLDLT and normalized(POD 14: 3.136±1.092, CI normal range 3-4 1/min/m^2). As regards renal function tests, when compare each factor by preoperative the 14th disease day, as CCr fall 75.9± 34.2 (ml/min) to 46.1±19.6. NAG shows 17.6±12.1(U/ to 14.0±11.6, it means the proximal tubule disorder. As for urine BMG shows729.9±2012.5 (μg/I) to 939.21±431.3, it means that the renal tubule and glomerulus disorder. FENa shows 1.2±1.1 (%) to 1.0±0.7, it does not show a change. Cr shows 1.2±1.1 (mg/dl) to 0.7±0.3, as for Cr, it improved.Conclusion: The characteristic of hemodynamics in ESLD patients is extremely large cardiac output, so-called hyperdynamic state. In this study, CI was significantly higher until POD 10 than before LDLT. Therefore, we think that hyperdynamic stage continue the minimum 10 days after LDLT. Although Cr value improved by LDLT, patent renal disorder existed, example for NAG and BMG value elevation. Although it was thought that the ICG test was extremely useful evaluation method for the circulation change of ESLD patient on perioperative period management, the improvement of the circulation change it doesn't necessarily mean improvement of the renal function. Therefore, we should have considered the factor except the circulation change when we thought about LDLT patient's renal function. Less