多巴酚丁胺和多巴胺对低心排综合征患者血流动力学和氧代谢的影响

目的：比较小剂量比巴胺及多巴酚丁胺对心脏手术后低心排综合征患者血流动力学和氧代谢的影响。方法：１２例心脏手术后低心排患者分别持续静脉泵入５￣１０μｇ·ｍｉｎ＾－１·ｋｇ＾－１多巴胺或多巴酚丁胺,观察血流动力流和氧代谢的改变。结果 与给药前相比,１０μｇ·ｍｉｎ＾－１·ｋｇ＾－１多巴胺和５￣１０μｇ·ｍｉｎ＾－１·ｋｇ＾－１多巴酚丁胺给药后均能显著提高心脏指数（Ｃ）,但仙样使ＣＩ增加５０％￣７０％,     

多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏器官灌注的影响

目的 :观察多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏灌注的影响。方法 :静脉注射内毒素 (L PS)复制绵羊感染性休克模型 ,当收缩压下降至低于 90 .0 0 m m Hg(1m m Hg=0 .133k Pa)或较L PS注射前降低 39.75 m m Hg时记录血流动力学及肠黏膜 p H(p Hi)的基础值。 2 0只绵羊随机分为两组 ,分别静脉注射多巴酚丁胺加去甲肾上腺素和多巴胺 ,调整药物剂量 ,使平均动脉压升高到 90 .0 0 mm Hg,观察药物使用前 (基础值 )及用药后 1、2、3、4 h的血流动力学和内脏灌注指标 p Hi。结果 :在 L PS注射前和基础状态 ,多巴胺组与多巴酚丁胺 +去甲肾上腺素组的血流动力学、氧代谢和肠道 p Hi指标均无明显差异 ;与基础值相比 ,两组动物在用药后血压、心脏指数及氧输送明显升高。多巴胺组用药 4 h动脉乳酸浓度及 p Hi水平与基础值比较无明显改变 ;但动脉 p H值基础水平为 7.4 0± 0 .0 5 ,多巴胺应用 1h后显著降低至 7.2 6± 0 .0 6 (P<0 .0 5 )。应用多巴酚丁胺加去甲肾上腺素后 3和 4 h,动脉乳酸浓度分别为 (2 .3± 1.1) m mol/ L 和 (2 .1± 1.1) m mol/ L,均显著低于基础水平 (4 .0± 1.8) m mol/ L(P<0 .0 5 )。应用多巴酚丁胺加去甲肾上腺素前动物 p Hi为 7.19±0 .0 4 ,用药后 3h,p Hi明显升高到     

多巴胺多巴酚丁胺治疗毛细支气管炎的疗效观察

目的　了解多巴胺、多巴酚丁胺治疗毛细支气管炎的疗效。方法　将 62例患毛细支气管炎的病儿随机分成两组 ,观察组 3 2例 ,对照组 3 0例 ,观察组在常规治疗的基础上加用多巴胺、多巴酚丁胺注射液 0 .6～ 1mg/kg加入 5 %葡萄糖注射液 3 0ml静滴 ,每日 1次 ,每 1疗程 5天。结果　两组疗效经统计学处理 ,总有效率 χ2 =5 .98,P <0 .0 5 ,治疗组效果明显优于对照组。结论　多巴胺、多巴酚丁胺治疗毛细支气管炎临床效果显著 ,值得推广。     

多巴胺和多巴酚丁胺治疗新生儿呼吸窘迫综合征32例分析

新生儿呼吸窘迫综合征（NRDS）为肺表面物质缺乏所致，是早产地呼吸衰竭最常见原因[1]。应用肺表面活性物质替代疗法降低了NRDS病死率及发病率[2]。但由于该药来源困难，价格昂贵，在基层不能广泛应用。我们试用多巴胺与多巴酚丁胺联合治疗NRDS32例，收到较好效果，现报道如下。1资料和方法1．1病例来源及分组：1992年6月～1997年5月我院新生儿病房收治的NRDS患儿62例，分为二组。治疗组32例，给予多巴胺及多巴酚丁胺。对照组30例，除不用多巴胶和多巴酚丁胺外，其它治疗措施相同。二组患儿均为早产及低出生体重儿。基本情况无差异，…     

多巴胺和多巴酚丁胺对婴幼儿重症肺炎的心血管功能支持作用

目的探讨多巴胺、多巴酚丁胺在重症婴幼儿肺炎时对心血管功能支持的早期干预作用和意义。方法将婴幼儿重症肺炎惠儿随机分为治疗组和对照组,对照组进行常规治疗,治疗组在常规治疗基础上加用多巴胺、多巴酚丁胺,比较两组住院、临床症状缓解时间,动态观察两组患儿收缩压和心率变化。结果治疗组较对照组住院、临床症状缓解时间明显缩短,差异有统计学意义（P〈0．01）,两组12h收缩压和心率监测差异无统计学意义（P〉0．05）。结论早期给予婴幼儿重症肺炎惠儿多巴胺、多巴酚丁胺心血管功能支持可提高疗效,缩短病程。     

多巴胺联合多巴酚丁胺在治疗小儿重症肺炎中的应用

选取我院2012年7月~2013年6月收治的84例小儿重症肺炎患者,按住院尾号分为治疗组和对照组各42例,对照组患者采用利巴韦林和阿奇霉素治疗,治疗组患者在对照组基础上加用多巴胺和多巴酚丁胺治疗,对比两组患者治疗效果。结果治疗组患者治疗总有效率为95.24%显著优于对照组的73.81%,差异有统计学意义(P0.05);治疗组患者体征改善时间显著优于对照组,差异有统计学意义(P0.05)。多巴胺联合多巴酚丁胺治疗小儿重症肺炎可有效改善患者临床症状,效果显著。     

多巴胺和多巴酚丁胺对临床部分生化检测项目的干扰

目的评估多巴胺和多巴酚丁胺对基于过氧化物和过氧化物酶反应原理的6个生化检测项目[肌酐(Cr)、尿酸(UA)、葡萄糖(Glu)、总胆固醇(TC)、甘油三酯(TG)、糖化血清蛋白(GSP)]的影响。方法配制含有100.00、50.002、5.00、12.506、.253、.131、.57μg/mL不同药物(多巴胺、多巴酚丁胺)浓度的血清,采用日立7600全自动生化仪(简称日立7600)测定血清Cr、UA、Glu、TC、TG、GSP浓度;采用强生VITROSR○5.1 FS干式生化仪(简称强生VITROS)检测Cr、UA和Glu浓度。计算不同血药浓度对各个项目干扰的程度。结果随着药物浓度逐渐增加,6个检测项目的检测结果均逐渐下降。血药浓度≤1.57μg/mL时对除GSP外的5个日立7600检测项目的负干扰<10%;血药浓度≥50μg/mL时对强生VITROS的Cr、UA测定结果的负干扰>10%。各个浓度的药物对强生VITROS检测Glu没有明显影响(<10%)。结论高浓度的多巴胺和多巴酚丁胺(≥1.57μg/mL)对日立7600的检测Cr、UA、Glu、TC、TG和GSP呈明显负干扰。强生VITROS抗多巴胺和多巴酚丁胺的干扰能力明显强于日立7600上的相应检测项目。     

多巴胺、多巴酚丁胺治疗顽固性心力衰竭临床观察

目的观察多巴胺与多巴酚丁胺联合治疗顽固性心力衰竭的效果。方法将40例顽固性心力衰竭患者随机分为对照组与治疗组,对照组20例按心力衰竭常规综合治疗,治疗组20例在常规综合治疗的基础上加用多巴胺与多巴酚丁胺静脉注射治疗。结果治疗组显效率55%,有效率40%,总有效率为95%;对照组显效率30%,有效率40%,总有效率为70%,两组疗效对比有统计学意义(2χ=7.9,P<0.01)。结论多巴胺与多巴酚丁胺联合治疗顽固性心力衰竭疗效好,副作用小。     

多巴胺、多巴酚丁胺佐治新生儿硬肿体会

新生儿硬肿是造成新生儿死亡的常见病。1990年以来．我科在治疗重度新生儿硬肿时．加用多巴胺和多巴酚丁胺，取得较好效果。     

多巴酚丁胺联合多巴胺治疗慢性肺原性心脏病难治性心力衰竭

多巴酚丁胺联合多巴胺治疗慢性肺原性心脏病难治性心力衰竭赵中苏粟奇志韩建中难治性心力衰竭（心衰）是指经卧床休息、低钠饮食、利尿剂、洋地黄和血管扩张剂等常规治疗无效的心衰。我们１９９３年以来用多巴酚丁胺联合多巴胺治疗３６例慢性肺原性心脏病（肺心病）难治性...     

容量状态对革兰氏阴性杆菌感染性休克患者血液动力学类型及氧代谢的影响

目的　探讨容量状态对感染性休克患者血液动力学状态及氧化谢的影响。方法　监测10例感染性休克患者不同容量状态下血液动力学及氧化谢的变化。结果　低血容量时,肺动脉嵌压(PAWP)0.8±0.3kPa,心脏指数(CI)2.0±0.4L     

The effects of beta blockade on dopamine and dobutamine induced hypokalaemia in dogs

The effect of beta₁ and beta₂ blockade on dopamine and dobutamine induced hypokalaemia was investigated in dogs. Arterial plasma potassium was continuously monitored using a potassium-sensitive electrode sited in the abdominal aorta. Dopamine and dobutamine were infused at 15g kg^-1 min^-1 into animals pre-treated with atenolol (0.5 mg kg^-1) or ICI 118551 (0.5 mg kg^-1) and the potassium changes compared to those seen in control animals. The inotrope infusions caused a small and transient rise in plasma potassium (p<0.05) followed by a more profound hypokalaemia (p<0.05) sustained for the duration of the infusion. The potassium falls in the control animals were similar to those in the beta₁ and beta₂ blockade groups. The results suggest that beta₂ receptor stimulation cannot alone be responsible for dopamine and dobutamine induced hypokalaemia and a multiple receptor activation is postulated.M. Smith and H.F. Drake were supported by a grant from the Sir Jules Thorn Charitable Trust     

Comparative haemodynamic effects of dopamine and dobutamine in septic shock

Septic shock associated with depressed myocardial function generally requires the use of catecholamine. Currently dopamine is often selected. Dobutamine is a newly developed catecholamine which has been shown to be of value in severe cardiomyopathic disease. The aim of this work was to determine the most appropriate drug by comparing haemodynamic responses to dopamine and dobutamine in 19 studies carried out in 11 patients with septic shock and heart failure. Cardiac index increased similarly with dopamine and dobutamine (33%), as did stroke volume (respectively 26.4 and 25%). Arterial pressure increased by 17% with dopamine whereas it did not significantly change with dobutamine due to reduction in vascular resistance of 19%. Dobutamine decreased filling pressure, either right (14%) or left (28%) whilst they slightly but unsignificantly increased with dopamine. Pulmonary shunting increased more with dopamine (47%) than with dobutamine (16%), but PaO₂ remained constant with both. Since septic shock is characterized by lowered arterial pressure and vasodilatation it is concluded that effects of dopamine on capacitance and resistance vessels make this drug more suitable. In addition it selectively increases renal blood flow. Nevertheless dobutamine could be appropriate, in case of very high filling pressures, severe peripheral vasoconstriction, marked pulmonary shunting and in some cases where dopamine becomes ineffective.     

Continuous multi-channel intravascular monitoring of the effects of dopamine and dobutamine on plasma potassium in dogs

The effects of dopamine and dobutamine on plasma potassium were investigated in dogs using continuous, multi-channel, intravascular ion-selective potassium electrodes situated in the aorta and abdominal and thoracic inferior vena cavae. Doses of 10 and 30 g kg^-1 min^-1 of each drug were used, and the effects on potassium compared with isoprenaline 0.07 and 0.2 g kg^-1 min^-1. Both the drugs caused a biphasic pattern of potassium change consisting of an initial small rise in the potassium level, followed by a sustained period of hypokalaemia. The changes were greater with the higher dose of each drug compared with the lower dose, but there were no significant differences between the drugs. Comparison of the potassium changes between the three vascular sites studied suggested that the rise in potassium may be a result of release of the ion from the liver, and that the liver may also be the principle site of potassium uptake during the hypokalaemic phase.     

Postcardiac surgery low cardiac output syndrome: dopexamine or dopamine?

Objective: To compare the efficacy and safety of dopexamine with dopamine in the treatment of low cardiac output syndrome after cardiac surgery. Design: This was a multicentre, double-blind, randomised, parallel-group study conducted in intensive care units at centres in Holland and Belgium. Patients were randomised to receive dopexamine (up to 2.0 μg/kg per min) or dopamine (up to 6.0 μg/kg per min) for 6 h after low cardiac output syndrome was confirmed. Results: 70 patients were enrolled (35/group) and there was no significant difference in the operative procedures or haemodynamics at entry into the study. Clinical efficacy, defined as a cardiac index > 2.5 l/min per m² with urine production > 0.5 ml/kg per h and stable haemodynamics for two consecutive readings 1 h apart, was achieved by 90 and 87 % of patients in the dopexamine and dopamine groups, respectively. However, more patients maintained clinical efficacy over the 6-h period in the dopexamine group, which was statistically significant at 1–2 h and approached significance at all other time points. Safety was assessed by comparing the adverse events and concomitant medication. Fewer patients on dopexamine had cardiac events compared with dopamine-treated patients (25 vs 38 events), although there was no difference in the pattern of rhythm disturbance. Fewer patients in the dopexamine group required concomitant vasodilating drugs (18 vs 30). Conclusion: Taking the proportion of patients achieving clinical efficacy, the time to achieve it and the maintenance of it along with the adverse event profile, dopexamine was shown to be an effective and safe drug to use in the management of low cardiac output syndrome after coronary artery bypass graft surgery and may be superior to dopamine. Received: 19 November 1996 Accepted: 8 July 1997     

多巴胺对恢复自主循环猪氧代谢的影响

目的 对心搏骤停心肺复苏(CPR)后自主循环恢复(ROSC)模型猪采用多巴胺升压,观察不同灌注条件对氧代谢的影响及神经功能恢复结果.方法 心室纤颤(VF)前将猪右股静脉连接连续心排血量监测仪,左颈内静脉置管并放置电极到右心室,分别行主动脉、颈动脉置管,采用电击致12头实验猪心搏骤停,VF 4 min后进行CPR,达到ROSC,按随机数字表法均分为高灌注组和正常灌注组.两组在4 h内均给予15 ml·kg-1·h-1生理盐水补液;高灌注组同时给予多巴胺持续静脉泵入升压,使平均动脉压(MAP)维持在复苏后基础血压的130%左右.于ROSC基础状态(0 h)及ROSC后0.5、1、2、4 h记录各组动物血流动力学参数并计算氧代谢各指标;24 h进行神经系统功能评价.结果 与正常灌注组比较,高灌注组ROSC 0.5、1、2、4 h氧输送量(DO2)、氧消耗量(VO2)明显升高[DO2(ml/min):556±43比375±25、660±56比381±53、674±53比362±44、685±44比400±38,VO2(ml/min):288±35比191±13、260±37比204±38、223±27比169±21、212±19比163±15,P＜0.05或P＜0.01];ROSC 1、2、4 h氧摄取率(ERO 2)明显下降[(39±4)%比(53±3)%、(33±2)%比(47±1)%、(31±3)%比(41±3)%,均P＜0.05];颈动脉血氧分压(PaO2)明显升高,但颈动脉血氧饱和度(SaO2)无差异;ROSC 0.5、1、2、4 h混合静脉血氧分压(PvO2,mm Hg,1 mm Hg=0.133 kPa)明显升高(38±4比33±1、42±2比36±2、40±2比36±2、43±2比38±1,P＜0.05或P＜0.01);ROSC 1、2、4 h混合静脉血氧饱和度(SvO2)和混合静脉血-颈动脉血乳酸含量差(PCLac)均升高[SvO2:0.60±0.04比0.45±0.03、0.66±0.02比0.52±0.01、0.68±0.03比0.58±0.03,PCLac(mmol/L):1.2±0.2比0.7±0.4、1.0±0.3比0.6±0.2、1.1±0.2比0.5±0.2,P＜0.05或P＜0.01];颈动脉氧含量(CAO2)升高,颈动-静脉氧含量差(CAvO2)、脑组织氧摄取率(C-ERO2)下降,颈动-静脉血乳酸含量差(VALac)升高.ROSC 24 h高灌注组6头猪均达到脑功能评分(CPC)1级;正常灌注组存活4头,其中3头达到CPC 2级,1头达到CPC 1级(P＜0.05).结论 在VF致心搏骤停模型猪ROSC后应用多巴胺升压,可以提高主动脉灌注压,改善全身和大脑灌注,对氧代谢、早期脑复苏有益.     

A comparison of dopamine,dobutamine and isoproterenol in the treatment of shock

Twelve patients in shock, defined as being present if the mean arterial blood pressure was less than 60 mm Hg, pulmonary arterial occlusion pressure was 15 mm Hg or greater, urine output was 20 ml or less for 2 consecutive hours, and there was clinical evidence of poor peripheral perfusion, underwent a comparative therapeutic trial with dopamine at 200 g · min^-1 and 400 g · min^-1 (2.5–5.5 g · kg^-1 · min^-1), dobutamine 250 g · min^-1 and 500 g · min^-1 (3.5–7 g · kg^-1 · min^-1) and isoproterenol 2 g · min^-1 and 4 g · min^-1 (0.025–0.055 g · kg^-1 · min^-1). Isoproterenol at 2 g · min^-1, produced a significant increase in pulse rate, cardiac output, left ventricular stroke work index and decrease in mean pulmonary blood pressure and pulmonary arterial occlusion pressure and at 4 g · min^-1 a significant increase in stroke volume, mixed venous oxygen tension and decrease in right atrial pressure and systemic vascular resistance was also observed. Dopamine at 200 g · min^-1 produced a significant increase in cardiac output, pulmonary arterial occlusion pressure and mixed venous oxygen tension and at 400 g · min^-1 a significant increase in pulse rate, mean arterial blood pressure mean pulmonary blood pressure, right ventricular stroke work index, right atrial pressure and pulmonary arterial occlusion pressure and decrease in arterial oxygen tension was also observed. Dobutamine at 250 g · min^-1 produced a significant increase in cardiac output, and at 500 g · min^-1 a significant increase in pulse rate, mixed venous oxgen tension and decrease in pulmonary arterial occlusion pressure.All agents increased pulse rate and cardiac output, although in the dosages chosen dopamine was the only agent do so with an increase in pulmonary arterial occlusion pressure and decrease in arterial oxygen tension. In patients in shock if an inotropic agent is considered necessary its pulmonary effect should be considered along with its effect on coronary and peripheral perfusion since dopamine may reduce arterial oxygenation.     

Effects of two inotropic drugs,dopamine and dobutamine,on pulmonary gas exchange in artificially ventilated patients

The inotropic agents, dopamine (DP) and dobutamine (DB), both decrease PaO₂, probably by a resistribution of the ratio. The aim of this study was to assess the effect of both drugs on the ratio, using the multiple inert gas elimination method. Ten artificially ventilated patients (eight males), aged 45–74 years were investigated. Blood gases, cardiac output and concentrations of inert gases were measured before and 30 min after infusion of DB or DP. DP and DB were administered alternatively at a rate of 5 g·k^-1 min^-1. The decrease in PaO₂ was significantly greater with DP (12±9 torr) than with DB (7±9 torr) (P< 0.01) Both drugs similarly increased cardiac ouput: +2.6l·min^-1±1.4 for DP and 2.2l·min^-1±1.5 for DB. Both DP and DB significantly (P< 0.01) increased the perfusion of alveoli with (+4±7% for DP and +3±7% for DB) and (+11±8.5% for DP and +5.5±10.5% for DB) (no significant difference between the drugs). When shunt and shunt-like effect are considered together, there was a significantly greater increase in the amout of blood going to alveoli with a low ratio with DP compared to DB. Both drugs decreased the perfusion of alveoli with , but the decrease was significantly less for DB than for DP (-15±6.5% for DP and-8.5±7% for DB,p< 0.01). We conclude that dopamine induces a greater degree of hypoxaemia compared to dobutamine due to a larger increase in shunt and/or maldistribution of the ratio.     

The effect of dobutamine infusion on splanchnic blood flow and oxygen transport in patients with acute pancreatitis

Objectives: To measure the blood flow distribution and oxygen transport in pancreatitis and to evaluate the regional effects of increased systemic blood flow. Design: Nonrandomized controlled trial. Setting: A general intensive care unit in a tertiary care center. Patients: 10 patients with pancreatitis requiring mechanical ventilation were studied after fluid resuscitation, and for the response to dobutamine, the patients served as their own controls. For the baseline, 11 patients scheduled for elective abdominal surgery served as a control group. Interventions: Systemic and regional hemodynamics were measured after fluid resuscitation to predefined hemodynamic endpoints. In patients with pancreatitis, the measurement was repeated after cardiac output had been increased by at least 25 % by dobutamine. Measurements and results: Hepatosplanchnic blood flow was estimated using regional catheterization and the dye dilution method. In patients with pancreatitis, the cardiac index did not differ from that of the control group (3.9 ± 0.8 vs 4.1 ± 0.7 l · min^–1· m^–2;NS). Accordingly, there was no difference in the splanchnic blood flow (1.1 ± 0.4 vs 1.2 ± 0.5 l · min^–1· m^–2;NS). Systemic and splanchnic oxygen consumption was increased in patients with pancreatitis (179 ± 25 vs 147 ± 27 ml · min^–1· m^–2, p < 0.05 and 68 ± 15 vs 49 ± 19 ml · min^–1· m^–2, p < 0.05), and systemic and splanchnic oxygen extraction was higher (0.34 ± 0.08 vs23 ± 0.05, p < 0.01 and 0.46 ± 0.18 vs 0.28 ± 0.08, p < 0.05, respectively). Dobutamine had inconsistent effects on splanchnic blood flow: in individual patients, splanchnic blood flow even decreased substantially. Conclusions: In severe pancreatitis, oxygen consumption is increased in the splanchnic region; increased splanchnic oxygen demand is not always met by adequately increased blood flow. Increasing the systemic blood flow with dobutamine does not improve perfusion in the splanchnic bed. Received: 24 September 1996 Accepted: 5 May 1997     

Effects of dopexamine,dobutamine or dopamine on prolactin and thyreotropin serum concentrations in high-risk surgical patients

Objectives Catecholamines are often used for optimisation of cardiac index and oxygen delivery in high-risk surgical patients; however, infusions of dopamine and dopexamine are associated with dose-dependent hypophysiotropic and thyreotropic properties. The objective was to compare endocrine effects of equipotent inotropic doses of dopexamine, dobutamine and dopamine on prolactin and thyreotropin release perioperatively.Design A prospective, randomised, blinded clinical trial.Setting Adult surgical intensive care unit in a university hospital.Patients Thirty male patients (ASA III) undergoing elective major abdominal surgery.Interventions Patients were randomised to receive dopexamine (DX, n=10), dobutamine (DO, n=10) or dopamine (DA, n=10) on the first postoperative day for 8 h.Measurements and results All patients received a catecholamine infusion in doses adjusted to increase cardiac index by 35% within the first hour. Blood samples were obtained and prolactin and thyreotropin serum concentrations were determined by radioimmunoassays. Mean doses of dopexamine, dobutamine and dopamine used were 0.73±0.27, 4.06±1.95 and 5.0±1.84 µg kg^–1min^–1, respectively. Cardiac index was increased by 36% (DX group), 38% (DO group) and 38% (DA group). Alterations of oxygen delivery and oxygen consumption were not significantly different between the study groups. Dopexamine and dobutamine had no hypophysiotropic effects. In contrast, dopamine suppressed prolactin and thyreotropin secretion with a maximal effect after 4 h. After dopamine withdrawal, a rebound release of prolactin and thyreotropin was observed.Conclusions In high-risk surgical patients dopexamine or dobutamine produced fewer effects on prolactin and thyreotropin serum concentrations in comparison with DA when used in equivalent dosages.