小剂量多巴胺和多巴酚丁胺对非少尿型肾功能衰竭的影响

目的探讨小剂量多巴胺和多巴酚丁胺对非少尿型肾功能衰竭患者肾功能的影响。方法29例血流动力学稳定的非少尿型肾功能衰竭患者,采用随机数字表法选择给药顺序,对照组给予质量分数为5%的葡萄糖,多巴胺组给予多巴胺5μg·kg-1·min-1,多巴酚丁胺组给予多巴酚丁胺5μg·kg-1·min-1;用微量注射泵持续静脉泵入一种药物4h后更换另一种药物,为消除上一种药物对各项监测指标的影响,每种药物更换前间隔1h再进入下一种药物观察阶段。每给一种药物后用SwanGanz导管监测患者的血流动力学指标变化;同时取血、尿测定肾功能指标。结果与对照组相比多巴胺、多巴酚丁胺能明显增加心率(HR)、心排血指数(CI)、尿量和肌酐清除率(CCr),差异均有显著性;多巴胺较多巴酚丁胺能更加明显地增加尿量和钠排泄分数(FeNa),差异均有显著性;而多巴酚丁胺增加CCr的程度与多巴胺比较差异无显著性。结论多巴胺和多巴酚丁胺对非少尿型肾功能衰竭均有增加HR、CI、尿量、FeNa和CCr的作用,多巴胺较多巴酚丁胺增加尿量和FeNa更明显,多巴酚丁胺增加CCr与多巴胺相比差异无显著性。

Comparison of effects of low-dose dopamine and dobutamine in patients with nonoliguric renal failure

Objective To investigate the effects of lowdose dopamine and dobutamine on renal function in patients with nonoliguric renal failure. Methods Twentynine hemodynamically stable patients with nonoliguric renal failure were enrolled to this study group. Each patient was given 5% glucose (control), dopamine or dobutamine in random order by means of an injection pump every 4 hours. The change in urine output, fractional excretion of sodium (FeNa) and creatinine clearance rate (CCr) were determined. Results Compared with control, urine volume, FeNa, and CCr were increased significantly after administration of dopamine, or dobutamine. Compared with dobutamine, dopamine could increase the urine output and the FeNa markedly, but there was no difference in CCr increase between dopamine and dobutamine. Conclusion Dopamine or dobutamine treatment could significantly increase the urine output, FeNa, and CCr in patients with nonoliguric renal failure. Dopamine infusion markedly increases urine output and the FeNa, but there is no significantly difference in CCr between dopamine and dobutamine treatment.