Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients
Direct comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients
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DOI：
10.1097/01.ccm.0000120054.32845.a6
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发表时间：
2004-04-01
影响因子：
8.8
通讯作者：
Menon, DK
中科院分区：
文献类型：
--
作者：
Steiner, LA;Johnston, AJ;Menon, DK
目的：直接比较去甲肾上腺素和多巴胺对急性颅脑损伤患者脑血管的影响。前瞻性随机交叉试验。设置。Neurosciences critical care unit of a university hospital.Patients：10 acute head injury patients requiring vasoactive drugs to maintain a cerebral perfusion pressure of 65 mm Hg.Interventions：Patients were randomized to start the protocol with either norepinephrine or dopamine.使用分配的药物的输注，将脑灌注压调节至65 mm Hg。数据收集20分钟后，通过增加血管活性剂的输注速率将脑灌注压增加至75 mm Hg。在数据收集20分钟后，将脑灌注压增加至85 mm Hg，并再次收集数据20分钟。随后，降低血管活性药物的输注速率，直至脑灌注压达到65 mm Hg，并将药物与其他药物交换。然后重复该方案。测量和主要结果。监测平均动脉压和颅内压，经颅多普勒估计脑血流量。去甲肾上腺素导致脑灌注压（57.5 +/- 19.9 cm（.）秒（-1），61.3 +/- 22.3 cm（.）sec（-1）和68.4 +/- 24.8 cm-sec（-1）（在65、75和85 mm Hg下分别为;所有三个比较p <0.05），但多巴胺的变化是可变的和不一致的。在任何脑灌注压水平下，两种药物之间的流速或颅内压绝对值均无差异。去甲肾上腺素可能更可预测和有效地增加脑外伤患者的脑灌注。
Objective: To directly compare the cerebrovascular effects of norepinephrine and dopamine in patients with acute traumatic brain injury.Design. Prospective randomized crossover trial.Setting. Neurosciences critical care unit of a university hospital.Patients: Ten acutely head-injured patients requiring vasoactive drugs to maintain a cerebral perfusion pressure of 65 mm Hg.Interventions: Patients were randomized to start the protocol with either norepinephrine or dopamine. Using an infusion of the allocated drug, cerebral perfusion pressure was adjusted to 65 mm Hg. After 20 mins of data collection, cerebral perfusion pressure was increased to 75 mm Hg by increasing the infusion rate of the vasoactive agent. After 20 mins of data collection, cerebral perfusion pressure was increased to 85 mm Hg and again data were collected for 20 mins. Subsequently, the infusion rate of the vasoactive drug was reduced until a cerebral perfusion pressure of 65 mm Hg was reached and the drug was exchanged against the other agent. The protocol was then repeated.Measurements and Main Results. Mean arterial pressure and intracranial pressure were monitored and cerebral blood flow was estimated with transcranial Doppler. Norepinephrine led to predictable and significant increases in flow velocity for each step increase in cerebral perfusion pressure (57.5 +/- 19.9 cm(.)sec(-1), 61.3 +/- 22.3 cm(.)sec(-1), and 68.4 +/- 24.8 cm-sec(-1) at 65, 75, and 85 mm Hg, respectively; p < .05 for all three comparisons), but changes with dopamine were variable and inconsistent. There were no differences between absolute values of flow velocity or intracranial pressure between the two drugs at any cerebral perfusion pressure level.Conclusions. Norepinephrine may be more predictable and efficient to augment cerebral perfusion in patients with traumatic brain injury.