Dopamine clearance in critically ill patients
Dopamine clearance in critically ill patients
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DOI：
10.1007/s001340050747
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发表时间：
1998-11-01
影响因子：
38.9
通讯作者：
Soni, N
中科院分区：
文献类型：
--
作者：
Juste, RN;Moran, L;Soni, N
目的：通过研究多巴胺的稳态清除率来检查危重患者低剂量“肾脏”多巴胺方案的有效性。设计：一项前瞻性临床研究设置：教学医院重症监护病房。患者：48 名接受多巴胺输注的血流动力学稳定的患者。干预措施：对动脉血和多巴胺输注液进行采样。测量和结果：通过以下方法测量血浆和输注液多巴胺水平：液相色谱与电化学检测。通过将实际输注速率除以稳态血浆浓度来确定稳态清除率。全组的多巴胺清除率为 46.4 +/- 35.9 ml/kg 每分钟（平均值 +/- SD），显着低于择期手术患者报告的 70 +/- 15.2 ml/kg 每分钟 (p = 0.01)。 12 名肾功能不全患者的多巴胺清除率（36 +/- 16.6 ml/kg 每分钟）显着低于其余 36 名患者（61 +/- 38.5 ml/kg 每分钟，p = 0.022）。整个组的血浆多巴胺水平与输注速度之间的相关性非常差（r = 0.47），并且当仅考虑那些每分钟 2-5 μg/kg 的“肾脏”剂量的患者（n = 30）时，这种情况会恶化（r = 0.31）。结论：危重患者的血浆多巴胺清除率较低，并且存在较大的个体差异。因此不可能从输注速度预测血浆水平。因此，选择性肾血管低剂量多巴胺输注的概念对于危重患者是无效的。
Objective: To examine the validity of the low-dose "renal" dopamine regimen in critically ill patients by investigating the steady-state clearance of dopamine.Design: A prospective clinical studySetting:Teaching hospital intensive care unit.Patients: 48 haemodynamically stable patients receiving a dopamine infusion.Interventions: Sampling of arterial blood and dopamine infusates.Measurement and results: Plasma and infusate dopamine levels were measured by liquid chromatography with electrochemical detection. Steady-state clearance was determined by dividing the actual infusion rate by the steady-state plasma concentration. Dopamine clearance for the whole group was 46.4 +/- 35.9 ml/kg per min (mean +/- SD), which is significantly lower than 70 +/- 15.2 ml/kg per min reported for elective surgical patients (p = 0.01). Twelve patients with renal dysfunction had significantly lower dopamine clearances (36 +/- 16.6 ml/kg per min) than the remaining 36 patients (61 +/- 38.5 ml/kg per min, p = 0.022). There was a very poor correlation between plasma dopamine level and infusion rate for the group as a whole (r = 0.47), and this worsened (r = 0.31)when only those patients on a "renal" dose of 2-5 mu g/kg per min were considered (n = 30).Conclusion: Plasma dopamine clearance is lower in critically ill patients and there is a large interindividual variation. It is therefore impossible to predict the plasma level from the infusion rate. Consequently, the concept of a selective renovascular low-dose dopamine infusion is invalid in critically ill patients.