Dive A, Foret F, Jamart J, Bulpa P, Installé E
Department of Intensive Care, Mont-Godinne University Hospital, Université Catholique de Louvain, Yvoir, Belgium.
Intensive Care Med. 2000 Jul;26(7):901-7. doi: 10.1007/s001340051279.
To document the action of dopamine on gastrointestinal motility in mechanically ventilated patients.
Crossover, randomized, placebo-controlled study.
General intensive care unit (ICU) in a university hospital.
Twelve mechanically ventilated patients in a stable hemodynamic condition, with no contraindication to enteral feeding.
Dopamine (4 microg/kg per minute) and placebo were infused over 8 h (4 h fasting, followed immediately by 4 h nasogastric feeding at 100 kcal per hour) on two consecutive days, in a random order. Pressure changes in the gastric antrum (four sites) and in the duodenum (two sites) were recorded by perfused catheter manometry. Each session started with the institution of dopamine or placebo infusion.
The migrating motor complex and its three successive phases were identified (phase I, period of quiescence; phase II, period of irregular contractile activity; phase III or activity front, period of high-frequency, regular contractions). Contractions and activity fronts at each site were quantified during fasting and feeding. The mean duration of the fasting migrating motor complex was determined in the duodenum, as well as the contribution of each phase (phases I, II, III) to the length of the complete cycle. The propagation characteristics of each activity front were assessed visually. The number of contractions was lower in the antrum (p = 0.024) and phase III motor activity higher in the duodenum [incidence of activity fronts (p = 0.008); number of phase III contractions (p = 0.009)] during dopamine infusion than with placebo. These modifications observed under dopamine were related to decreased antral contractions during fasting (p = 0.050), increased incidence of activity fronts during feeding (p = 0.031), and increased number of phase III contractions during fasting (p = 0.037). In both groups (placebo and dopamine) activity fronts rarely started in the antrum, and abnormally propagated activity fronts were found in the duodenum in some patients.
Low-dose dopamine adversely affects gastroduodenal motility in mechanically ventilated critically ill patients.
记录多巴胺对机械通气患者胃肠动力的作用。
交叉、随机、安慰剂对照研究。
大学医院的综合重症监护病房（ICU）。
12例血流动力学稳定的机械通气患者，无肠内营养禁忌证。
多巴胺（4微克/千克每分钟）和安慰剂在连续两天内以随机顺序输注8小时（禁食4小时，随后立即以每小时100千卡的速度进行4小时鼻饲）。通过灌注导管测压法记录胃窦（四个部位）和十二指肠（两个部位）的压力变化。每个疗程从输注多巴胺或安慰剂开始。
识别出移行性运动复合波及其三个连续阶段（第一阶段，静止期；第二阶段，不规则收缩活动期；第三阶段或活动前沿，高频、规则收缩期）。在禁食和进食期间对每个部位的收缩和活动前沿进行量化。在十二指肠中确定禁食移行性运动复合波的平均持续时间，以及每个阶段（第一阶段、第二阶段、第三阶段）对完整周期长度的贡献。通过视觉评估每个活动前沿的传播特征。与安慰剂相比，输注多巴胺期间胃窦收缩次数减少（p = 0.024），十二指肠第三阶段运动活动增加[活动前沿发生率（p = 0.008）；第三阶段收缩次数（p = 0.009）]。在多巴胺作用下观察到的这些改变与禁食期间胃窦收缩减少（p = 0.050）、进食期间活动前沿发生率增加（p = 0.031）以及禁食期间第三阶段收缩次数增加（p = 0.037）有关。在两组（安慰剂组和多巴胺组）中，活动前沿很少在胃窦开始，并且在一些患者的十二指肠中发现了异常传播的活动前沿。
低剂量多巴胺对机械通气的重症患者胃十二指肠动力有不利影响。
