SYSTEMIC AND RENAL EFFECTS OF DOPAMINE IN THE INFANT PIG
SYSTEMIC AND RENAL EFFECTS OF DOPAMINE IN THE INFANT PIG
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DOI：
10.1016/0022-4804(82)90129-9
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发表时间：
1982-01-01
影响因子：
2.2
通讯作者：
GROSFELD, JL
中科院分区：
文献类型：
--
作者：
VANE, DW;WEBER, TR;GROSFELD, JL
多巴胺通常用于低血压患者的治疗。虽然这种药物增加成人心脏指数（CI）和肾动脉（RA）流量，但其对婴儿的影响尚未得到充分研究。13头仔猪（平均体重3.05±0.75 kg，年龄3-4周龄）在给予多巴胺前后不同肾动脉灌注压力下测量CI、RA流量和全身血压（BP）。猪用氯胺酮麻醉，插管，用琥珀酰胆碱维持呼吸机。放置颈静脉、肺（Swan-Ganz）、颈动脉和股动脉导管。开腹手术，电磁流量探头测量RA流量。在80和50 mm Hg的压力下，在肾上主动脉周围放置Blalock钳以获得分级的主动脉闭塞。多巴胺在5、10、15、20、25或50 μg/kg/min时对CI没有显著影响。多巴胺组血压升高25 mm Hg (10 μg/kg/min)P < 0.05)。尽管灌注压降至80 mm Hg， RA流量仍保持稳定（318±74 vs 300±68 ml/min），提示RA流量存在自动调节机制。然而，在50 mm Hg灌注压力下，RA流量显著下降至220±54 ml/min (P< 0.05)，表明在低灌注压力下RA失去了自动调节能力。多巴胺（10 μg/kg/min）在对照血压（335±76 vs 318±74 ml/min）下未改变RA流量。然而，在80 mm Hg灌注压力下，RA流量从335±74 ml/min下降到175±50 ml/min (P< 0.001)，表明多巴胺抑制了肾脏的自动调节。在50 mm Hg时，RA流量明显降低至22±31 ml/min （P< 0.001）。这些数据表明：(1)多巴胺对仔猪CI无显著影响；(2)在低灌注压力下，仔猪存在RA血流机制，保护肾脏；(3)多巴胺干扰自身调节，可能对低血压状态下的婴儿肾脏有害。
Dopamine is commonly employed in the management of hypotensive patients. Although this medication increases cardiac index (CI) and renal artery (RA) flow in adults, its effect in infants has not been adequately studied. In 13 infant pigs (mean wt 3.05 ± 0.75 kg; age 3–4 weeks) CI, RA flow and systemic blood pressure (BP) were measured at varying renal artery perfusion pressures before and after the administration of dopamine. Pigs were anesthetized with ketamine, intubated, and maintained on a ventilator with succinylcholine. Jugular vein, pulmonary (Swan-Ganz), carotid, and femoral artery catheters were placed. Laparotomy was performed and RA flow was measured with an electromagnetic flow probe. A Blalock clamp was placed around the suprarenal aorta to obtain graded aortic occlusions to pressures of 80 and 50 mm Hg. Dopamine had no significant effect on the CI vs control at 5, 10, 15, 20, 25, or 50 μg/kg/min. BP increased 25 mm Hg on Dopamine (10 μg/kg/min)P> 0.05). RA flow remained stable (318 ± 74 vs 300 ± 68 ml/min) despite reduction in perfusion pressure to 80 mm Hg, suggesting an autoregulatory flow mechanism. At 50 mm Hg perfusion pressure however, RA flow decreased significantly to 220 ± 54 ml/min (P< 0.05) indicating a loss of autoregulation at lower perfusion pressures.Dopamine (10 μg/kg/min) did not change RA flow at control BP (335 ± 76 vs 318 ± 74 ml/min). At 80 mm Hg perfusion pressure however, RA flow fell from 335 ± 74 to 175 ± 50 ml/min (P< 0.001) demonstrating a suppression of renal autoregulation by dopamine. At 50 mm Hg, RA flow was markedly reduced to 22 ± 31 ml/min (P< 0.001). These data suggest: (1) dopamine has no significant effect on CI in infant pigs, (2) an RA flow mechanism is present in infant pigs which protects the kidney at reduced perfusion pressures, and (3) dopamine interferes with autoregulation and may be harmful to the infant kidney in hypotensive states.