维持性血液透析患者营养不良情况及其影响因素分析

目的:分析维持性血液透析(MHD)患者营养不良发生率以及营养不良的影响因素。方法:选择2015年~2016年在我院进行MHD治疗的142例患者作为研究对象,采用改良定量主观整体评估表(MQSGA)结合实验室生化指标、人体测量学指标综合评估透析患者营养状况,并分析MHD患者发生营养不良的危险因素。结果:MQSGA评估结果显示营养正常组有63例,占总人数44.37%,营养不良组有79例,占总人数55.63%,其中轻中度营养不良有68例,占总人数47.88%,重度营养不良有11例,占总人数7.74%。营养正常与营养不良组间CRP、Alb、BUN、TSF、BMI、kt/v、年龄、透析龄比较差异有统计学意义(P0.05)。Logistics回归模型结果显示KT/V1.2,年龄、透析龄、Alb是营养不良的独立危险因素。结论:MHD患者营养不良的发生率较高,影响因素多,其中KT/V1.2,年龄、透析龄、Alb是其危险因素,可作为评估患者营养状况的指标。     

维持性血液透析患者抑郁与营养不良及高同型半胱氨酸血症的关系

目的:研究维持性血液透析(maintenance hemodialysis patients,MHD)患者抑郁状况与营养不良及高同型半胱氨酸血症(hyperhomocysteinemia,HHcy)的关系;并进一步探讨导致MHD患者抑郁的可能机制。方法:应用24项汉密尔顿抑郁量表(HAMD24)评分将104例MHD患者分为抑郁组和非抑郁组;比较两组患者营养不良炎症(MIS)评分及叶酸、维生素B12(VitB 12)、同型半胱氨酸(Hcy)、血白蛋白(Alb)、血红蛋白(Hb)等相关生化指标的差异,并分析其与抑郁评分的相关关系,应用二项Logistic回归方程分析抑郁发生的独立危险因素。结果:104例患者,抑郁组50例,非抑郁组54例,抑郁的发生率为48.1%;抑郁组和非抑郁组MIS评分、叶酸、Hcy、Alb、Hb及PTH之间的差异有统计学意义(P0.05)。抑郁评分与叶酸、Alb、Hb呈显著负相关(r=-0.400,P=0.003;r=-0.462,P=0.001;r=-0.360,P=0.009),与MIS评分、Hcy及PTH呈正相关(r=0.301,P=0.030;r=0.477,P=0.000;r=0.284,P=0.042);血清Hcy浓度与叶酸、VitB 12均呈显著负相关(r=-0.403,P=0.003;r=-0.276,P=0.047);Logistic回归方程分析显示Alb和Hcy为抑郁发生的独立危险因素(OR=0.611,95%CI=0.379~0.987,P=0.044;OR=1.349,95%CI=0.813~0.971,P=0.009)。结论:抑郁在MHD患者发生率高且与营养不良及HHcy密切相关,Alb和HHcy为抑郁发生的独立危险因素。     

不同血液净化方式对维持性血液透析患者血浆同型半胱氨酸的影响

目的观察不同血液净化方式对维持性血液透析(MHD)患者血浆同型半胱氨酸(Hcy)的清除效果。方法选取上海市第二人民医院肾内科MHD患者70例,按随机数字表法简单随机化分为常规血液透析(HD)组24例、HD联合血液灌流(HP)组23例、血液透析滤过(HDF)组23例。分别于首次透析前后以及治疗1年后透析前采血,检测血浆Hcy浓度、血肌酐(SCr)、尿素氮(BUN),并进行统计分析比较。结果治疗前及首次透析后3组血浆Hcy组间比较,差异无统计学意义(P0.05);首次透析前后3组血浆Hcy组内比较,差异均有统计学意义(P0.01)。HD+HP组Hcy清除率高于HD组(P0.01)及HDF组(P0.05),差异有统计学意义;HDF组与HD组Hcy清除率比较,差异无统计学意义(P0.05)。3组尿素氮下降率、单室尿素清除分数比较,差异无统计学意义(P0.05)。治疗1年后,HD组血浆Hcy与治疗前比较,差异无统计学意义(P0.05);HD+HP组、HDF组血浆Hcy与治疗前比较,差异均有统计学意义(P0.01)。治疗1年后Hcy下降率比较,HD+HP组和HDF组明显高于HD组,差异均有统计学意义(P0.05);HD+HP组与HDF组比较,差异无统计学意义(P0.05)。结论MHD患者普遍存在高同型半胱氨酸血症,HD联合HP治疗及HDF治疗,均可有效降低MHD患者血浆Hcy浓度。     

胱抑素C对维持性血液透析患者肌肉减少症的预测价值分析

目的:探讨胱抑素C(Cys C)对维持性血液透析患者肌肉减少症的预测价值。方法:2018年1月—2019年9月间在本院进行MHD的终末期肾病患者168例作为MHD组,根据肌肉减少症发生情况将MHD患者分为肌肉减少症组、非肌肉减少症组,对比其临床资料差异并进一步采用logistics回归模型分析促使MHD患者肌肉减少症出现的危险因素。采用受试者工作特征(ROC)曲线分析Cys C对MHD患者肌肉减少症出现的预测价值。结果:肌肉减少症组、非肌肉减少症组患者年龄及Alb、Scr、CRP、Cys C水平的分布差异有统计学意义(P0.05);性别、BMI、透析方式、透析时间、原发病及Hb、Ca~(2+)、P~(3-)、iPTH、TG水平的分布差异无统计学意义(P0.05)。Logistics回归分析结果显示,年龄较大,Alb水平较低,Scr、CRP、Cys C水平较高分别是MHD患者肌肉减少症发生的独立危险因素。ROC曲线显示,Cys C预测MHD患者发生肌肉减少症的最佳截断值为1.325 mg/L,AUC为0.815[95%CI 0.743～0.887],对应的灵敏度、特异度分别为69.84%、69.05%。结论:Cys C水平较高是MHD合并肌肉减少症的独立危险因素,且早期测定Cys C水平对肌肉减少症发生具有预测价值。     

高通量血液透析对肾性贫血的影响

目的:探讨高通量血液透析治疗肾性贫血的疗效。方法:维持血液透析患者73例。随机分为低通量透析组(LFHD组)和高通量透析组(HFHD组),共治疗6个月。监测患者血常规、白蛋白(albumin,Alb)、全段甲状旁腺激素(intact parathyroidism hormone,iPTH)、C-反应蛋白(C-reactive protein,CRP)、β2-微球蛋白(β2-microglobulin,β2-MG)等参数。记录留取静脉血前4周重组人促红素(recombinant human erythropoietin,r-HuEPO)的应用总量,以每周应用总量同血细胞比容(hematoccrit,Hct)的比值(EPO/Hct)作为评价r-HuEPO低反应的指标。比较两组患者上述指标的差别。结果:(1)LFHD组患者低通量普通透析治疗6月后,Hb、Hct、EPO/Hct、Alb、iPTH、CRP、β2-MG较试验前无明显变化(P>0.05)(2)HFHD组患者高通量血液透析治疗6个月后,Alb、Hb、Hct较试验前升高(P<0.05);EPO/Hct、CRP、β2-MG较治疗前减低(P<0.05);iPTH较治疗前略减低(P>0.05)。(3)试验结束时,HFHD组患者Alb较LFHD组高(P<0.05);Hb、Hct较LFHD组试验结束略高(P>0.05);EPO/Hct、CRP、β2-MG较LFHD组试验结束时低(P<0.05);iPTH较LFHD组试验结束时低(P>0.05)。(4)HFHD组患者治疗后Alb增加较LFHD明显,HFHD组患者治疗后CRP、MG、EPO/Hct减低较LFHD明显,差异具有统计学意义(P<0.05)。结论:高通量血液透析可以加强尿毒症患者中分子毒素的清除,改善患者的微炎症状态和营养不良,有利于改善EPO低反应性。     

抗坏血酸对维持性血液透析患者血清Hepcidin的影响

目的：观察抗坏血酸对维持性血液透析（MHD）患者血清铁调素（Hepcidin）的影响。方法：选择符合条件的MHD患者60例,分为治疗组和对照组各30例。治疗组每日口服抗坏血酸300 mg,共12周,对照组不服用抗坏血酸及其他抗氧化剂。检测两组实验前后血清Hepcidin、血红蛋白（Hb）、白蛋白（Alb）、C反应蛋白（CRP）、铁蛋白（SF）、白细胞介素（IL-6）等相关指标,比较两组指标的变化。结果：两组实验前各项指标差异无统计学意义。治疗组口服抗坏血酸12周后,血CRP、IL-6水平下降,差异有统计学意义（P〈0.05）;Hepcidin、SF、Hb、Alb差异无统计学意义。对照组实验前后各项试验指标差异无统计学意义。结论：口服抗坏血酸在一定程度上降低MHD患者血CRP、IL-6水平,但对Hepcidin未产生显著影响。     

微炎症状态与尿毒症并发症的关系

目的:探讨微炎症状态与尿毒症并发症贫血、营养不良、动脉粥样硬化性心脑血管疾病(CVD)之间的关系.方法:检测75例尿毒症患者血清C反应蛋白(CRP)、血红蛋白(Hb)、血浆白蛋白(Alb)、血肌酐(Scr)、颈动脉B超指标和CVD发生率;分析微炎症状态与尿毒症并发症的关系.结果:尿毒症透析组与非透析组CRP均在正常范围内,但明显高于肾功能正常的对照组(P＜0.01),且透析组又高于非透析组(P＜0.05).透析组与非透析组在贫血、营养不良、CVD等方面有统计学差异(P＜0.05),且CRP与Hb、Alb呈负相关,与CVD、颈总动脉内膜-中层厚度(intima-mediathickness,IMT)呈正相关.尿毒症合并动脉粥样硬化性CVD阳性组,CRP升高,Hb、Alb降低,与阴性组比较有统计学差异(P＜0.01),但仍然在正常范围内.结论:微炎症状态参与了尿毒症并发症贫血、营养不良、动脉粥样硬化性心脑血管疾病的发生与发展.     

叶氏升压方脐疗改善血液透析相关性低血压的临床研究

目的:观察叶氏升压方脐疗改善血液透析相关性低血压的疗效。方法:84例血透相关性低血压患者随机分为对照组和中药脐疗组,对照组采用西医常规治疗方法加血液透析治疗加米多君治疗,中药脐疗组采用西医常规治疗方法血液透析治疗加叶氏升压方脐疗,疗程共12周,观察透析中及透析后低血压发生率、病情严重程度、西医常规措施干预次数、提前中断血液透析次数及患者0周、12周的血红蛋白(Hb)、血浆白蛋白(Alb)、超敏C反应蛋白(hs-CRP)水平。结果:中药脐疗组透析中及透析后低血压发生率、西医常规措施干预次数、提前中断血液透析次数低于对照组,差异有统计学意义(P 0. 05),12周后中药脐疗组Hb、Alb水平高于对照组(P 0. 05),而hs-CRP表达水平则低于对照组(P 0. 05)。结论:叶氏升压方脐疗能够明显改善血液透析性低血压,该治疗方法值得临床推广,其升压机制可能与改善患者营养状态、提高血浆胶体渗透压及改善炎症状态有关。     

Palindrome导管晚期功能不良影响因素分析

目的:探讨Palindrome导管晚期功能不良的影响因素。方法:对我院使用Palindrome导管的维持性血液透析患者53例进行回顾性分析。记录置管时患者的年龄、性别、原发病、置管部位、管尖位置、临时导管留置时间、血红蛋白(Hb)、红细胞压积(Hct)、血小板(Plt)、白蛋白(Alb)、总胆固醇(TC)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT),记录出现导管晚期功能不良前1月内透析期间低血压发生次数、最近3次透析超滤率,记录导管带管时间、晚期导管功能不良出现的时间。用Cox风险回归分析导管晚期功能不良的影响因素。结果:单因素Cox回归分析显示原发病、置管部位、临时导管留置时间、低血压发生次数、Hct、超滤率与导管晚期功能不良相关,差异有统计学意义(P<0.05);而年龄、性别、管尖位置,Hb、Plt、Alb、TC、PT、APTT等因素与导管晚期功能不良无相关性,差异无统计学意义(P>0.05)。多因素Cox回归分析显示置管部位、Hct、超滤率是导管晚期功能不良的独立影响因素,相对危险度分别为2.310、1.254、1.623,差异有统计学意义(P<0.05);Hct、超滤率越高,导管晚期功能不良的发生率越高。结论:置管部位、Hct、超滤率是Palindrome导管晚期功能不良的独立影响因素,应优先选择右侧颈内静脉为置管部位、维持合适的Hct值、减少超滤率以降低导管晚期功能不良的发生率。     

老年维持性血液透析患者死因分析

目的：探讨老年维持性血液透析（ MHD）患者的死亡原因及相关危险因素。方法：回顾性分析2009年9月~2013年10月在我院行MHD治疗的76例老年患者，统计死亡原因；比较死亡组（研究组）和存活组（对照组）间的人口学资料、原发疾病、透析3个月时的血红蛋白、血清白蛋白、钙、磷等相关临床指标；分析死亡的危险因素。结果：心血管疾病、感染、脑血管疾病和消化道出血是老年MHD患者的主要死亡原因；与存活组相比，死亡组患者中男性多于女性（P〈0.05）；使用导管作为血管通路的患者多于使用动静脉内瘘的患者（P〈0.05）；患者的透析龄、BMI、透析3个月时的Hb、Hct、Alb、TC、P3-、iPTH、Scr低于存活组患者（P〈0.05）；CRP高于存活组患者（P〈0.05）。 Logistic回归分析显示，高CRP和低iPTH是死亡的独立危险因素（P〈0.05）。结论：在老年MHD患者中，心血管疾病是首要的死亡原因；高CRP和低iPTH是死亡的独立危险因素。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.