小剂量多巴胺对体外循环下心脏瓣膜置换术老年患者肾血流的影响  

Effects of small dose of dopamine on renal blood flow in elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass

作　　者：戴双波[1] 李晖[1] 齐娟[1] 

机构地区：[1]福建医科大学省立临床医学院福建省立医院麻醉科,福州市350001

出　　处：《中华麻醉学杂志》2014年第7期809-811,共3页Chinese Journal of Anesthesiology

基　　金：福建省卫生厅医学创新项目（2011-CX-4）

摘　　要：目的 评价小剂量多巴胺对体外循环（CPB）下心脏瓣膜置换术老年患者肾血流的影响.方法 择期CPB下行心脏瓣膜置换术老年患者60例,ASA分级Ⅱ或Ⅲ级,年龄65～74岁,体重52 ～ 77 kg,采用随机数字表法,将其分为2组（n=30）：生理盐水对照组（C组）和多巴胺组（D组）.手术开始后常规建立CPB,D组于首次灌注心脏停搏液后10 min,开始静脉输注多巴胺2μg·kg-1·min-1,持续20 min停药,C组以等容量生理盐水替代.于多巴胺给药前、给药结束后分别采用经食管超声测定左侧肾动脉主干血流速度,记录平均动脉压（MAP）.术前及术后24h抽血检测血浆尿素氮浓度.结果 与术前比较,2组术后24 h时血浆尿素氮浓度升高（P＜0.05）;2组给药前后MAP和肾动脉血流速度比较差异无统计学意义（P＞0.05）.结论 小剂量多巴胺（2μg·kg-1·min-1）不能增加CPB下心脏瓣膜置换术老年患者肾血流,不能改善老年患者术后肾功能.Objective To evaluate the effects of small dose of dopamine on the renal blood flow in the elderly patients undergoing cardiac valve replacement under cardiopulmonary bypass （CPB）.Methods Sixty elderly patients,of ASA physical status Ⅱ or Ⅲ,aged 65-74 yr,weighing 52-77 kg,scheduled for elective cardiac valve replacement under CPB,were randomized to receive either normal saline （group C,n =30） or dopamine （group D,n =30）.After beginning of surgery,CPB was established routinely.In group D,dopamine was continuously infused for 20 min at a rate of 2 μg· kg-1 · min-1 starting from 10 min after the hearts were perfused with cardioplegic solution for the first time,while the equal volume of normal saline was given in group C.The left renal blood flow velocity was measured by transesophageal echocardiography and mean arterial pressure was recorded before and after dopamine infusion.Blood samples were obtained before surgery and at 24 h after surgery for determination of blood urea nitrogen concentrations.Results Blood urea nitrogen concentrations were significantly increased at 24 h after surgery than that before surgery in the two groups.There was no significant difference in mean arterial pressure and the left renal blood flow velocity before and after dopamine infusion between the two groups.Conclusion Small dose of dopamine （2 μg· kg-1· min-1） dose not increase the renal blood flow or improve the postoperative renal function in the elderly patients undergoing cardiac valve replacement under CPB.

关 键 词：多巴胺 肾循环 心肺转流术 老年人 心脏瓣膜假体植入 

分 类 号：R614[医药卫生—麻醉学]