小剂量多巴胺对腹腔镜围手术期肾功能及血流动力学的影响

目的探讨小剂量多巴胺对腹腔镜围手术期患者肾功能及血流动力学的影响。方法拟在腹腔镜下行全子宫切除手术40例,采用随机数字表随机分为多巴胺组（20例）和对照组（20例）。2组均采用静吸复合全身麻醉,多巴胺组在气腹前10min开始静脉持续泵注多巴胺（每分钟5μg/kg）直到手术结束,2组气腹前（T1）、气腹后60min（T2）和解除气腹后30min（T3）抽静脉血检测尿素氮（BUN）、肌酐（Cr）、尿酸（UA）,并记录心率（HR）、平均动脉压（MAP）,测量术中尿量。结果多巴胺组BUN、Cr、HR、MAP各时点无明显变化,UA于T2、T3时点明显降低,与T1及对照组相同时点的UA值比较差异有显著性（P〈0.05）,术中尿量明显多于对照组[（396±51）mlvs（121±15）ml,t=22.836,P=0.000];对照组气腹后60min（T2）HR减慢、MAP降低,与气腹前（T1）及同时间点多巴胺组比较差异有显著性（P〈0.05）。结论小剂量多巴胺可以降低血尿酸及增加尿量,改善肾功能,同时还可以有效维持患者血流动力学稳定。

Effect of Low-dose Dopamine on Peri-postoperative Renal Function and Hemodynamics in Patients Underging Laparoscopy

Objective To investigate the influence of low dose （DA） Dopamine on renal function and hemodynamic parameter in patients undergoing laparoscopic operations. Methods A total of 40 patients undergoing laparoscopic surgery were randomly divided into two groups： DA and control groups. Bothe the groups underwent general anesthesia via intravenous and inhaled routes. The patients in DA group were administrated intravenous infusion of DA （5 μg/kg/min） from 10 minutes before pneumoperitoneum to the end of the operation, while the control group received no DA. During the operation, the serum levels of BUN, Cr, and UA, HR, MAP and urine volume were determined at three time points： before pneumoperitoneum （T1）, 60 minutes after CO2 pneumoperitoneum （T2）, and 30 mintues after the lifting of pneumoperitoneum （T3）. Results In DA group, the levels of BUN and Cr, HR and MAP at T2 and T3 did not change significantly compared with those at T1, but the levels of UA were significantly lower than that at T1 （P0.05）. Furthermore, the urine volume in DA group was significantly higher than that in the control [（396±51）ml vs （121±15）ml,t=22.836,P=0.000].In the control group,HR and MAP decreased significantly at T2 compared to T1,as well as the values of DA group at T2. Conclusions DA with a low dose can reduce the serum concentration of UA, increase urine volume, and improve renal function. In addition, it can effectively maintain the stability of hemodynamic parameter in patients undergoing laparoscopic surgery.