Wahbah A M, el-Hefny M O, Wafa E M, el-Kharbotly W, el-Enin A A, Zaglol A, Atallah M M
Department of Anesthesia, Mansoura University, Egypt.
Hepatogastroenterology. 2000 Nov-Dec;47(36):1691-4.
BACKGROUND/AIMS: The effectiveness of dopamine alone or in combination with mannitol or furosemide in preventing postoperative renal dysfunction in patients with obstructive jaundice was assessed in this study.
Forty patients having obstructive jaundice were randomly allocated into 4 equal groups. Preoperative hydration was performed by infusing all patients 1L of 5% dextrose the night before surgery and another 1L in the morning before surgery. Intra- and postoperative maintenance of adequate intravascular volume was assured by fluid and blood replacement guided by the monitoring of central venous pressure urine output and blood pressure. The 1st group was kept as a control. The other 3 groups received dopamine 2.5 micrograms/kg/min for 2 postoperative days starting before surgery. The 2nd group was maintained on dopamine alone, while mannitol (0.25 g/kg), every 12 hours for 2 postoperative days, was added to the 3rd group. Similarly furosemide (1 mg/kg) every 12 hours for 2 postoperative days, was infused to the patients of the 4th group. Postoperative renal functions were assessed by 24-hour urine output, serum creatinine, creatinine clearance and urine to plasma osmolality ratio.
All these tests did not show significant changes in the 1st, 2nd and 7th postoperative days. Only transient decreased creatinine clearance and elevated serum creatinine were observed in the patients of the 4th group in the 1st and 2nd postoperative days. This may be attributed to fluid imbalance induced by furosemide in these patients who were older than the other groups.
The study showed that careful attention to perioperative hydration is the cornerstone in preserving adequate renal function following surgery in patients with obstructive jaundice. Administration of dopamine alone or in combination with mannitol or furosemide did not confer more renal protection.
背景/目的：本研究评估了多巴胺单独使用或与甘露醇或呋塞米联合使用对预防梗阻性黄疸患者术后肾功能不全的有效性。
40例梗阻性黄疸患者被随机分为4组，每组人数相等。术前补液方法为：所有患者在手术前一晚输注1L 5%葡萄糖溶液，手术当天早晨再输注1L。术中及术后通过监测中心静脉压、尿量和血压，以补液和输血的方式确保血管内容量充足。第1组作为对照组。其他3组在术前开始接受2.5微克/千克/分钟的多巴胺治疗，持续2天。第2组仅使用多巴胺，第3组在使用多巴胺的基础上，术后2天每12小时加用甘露醇（0.25克/千克）。同样，第4组患者术后2天每12小时输注呋塞米（1毫克/千克）。通过24小时尿量、血清肌酐、肌酐清除率和尿渗透压与血浆渗透压比值评估术后肾功能。
所有这些检测在术后第1天、第2天和第7天均未显示出显著变化。仅第4组患者在术后第1天和第2天出现短暂的肌酐清除率下降和血清肌酐升高。这可能归因于在这些年龄比其他组大的患者中，呋塞米导致的液体失衡。
该研究表明，对于梗阻性黄疸患者，术后保持肾功能的关键在于围手术期的补液管理。单独使用多巴胺或与甘露醇或呋塞米联合使用并不能提供更多的肾脏保护。
