多巴胺、多巴酚丁胺和多培沙明对脓毒症和麻醉期间胃肠道微循环血流的影响。

Effects of dopamine, dobutamine, and dopexamine on microcirculatory blood flow in the gastrointestinal tract during sepsis and anesthesia.

作者信息

Hiltebrand Luzius B, Krejci Vladimir, Sigurdsson Gisli H

机构信息

Department of Anesthesia, Experimental Laboratory, Experimental Surgical Institute, University of Berne, Inselspital, Berne, Switzerland.

出版信息

Anesthesiology. 2004 May;100(5):1188-97. doi: 10.1097/00000542-200405000-00022.

DOI:10.1097/00000542-200405000-00022

PMID:15114217

Abstract

BACKGROUND

Insufficient blood flow to the splanchnic organs is believed to be an important contributory factor for the development of organ failure after septic shock. It has been suggested that increasing systemic flow also may improve splanchnic blood flow in septic patients. The aim of this study was to compare the effects of three commonly used inotropic agents, dopamine, dobutamine, and dopexamine, on systemic (cardiac index), regional (superior mesenteric artery), and local (micro-circulatory) blood flow during septic shock in pigs.

METHODS

Eight pigs were intravenously anesthetized, mechanically ventilated, and exposed to sepsis induced by fecal peritonitis. Cardiac index was measured with thermodilution, superior mesenteric artery flow was measured with ultrasound transit time flowmetry, and microcirculatory blood flow was continuously measured with a six-channel laser Doppler flowmetry in the gastric, jejunal, and colon mucosa as well as in the kidney, pancreas, and jejunal muscularis. Each animal received, in a random-order, crossover design, the three test drugs, one at a time: 5 and 10 microg x kg(-1) x min(-1) dopamine, 5 and 10 microg x kg(-1) x min(-1) dobutamine, and 1 and 2 microg x kg(-1) x min(-1) dopexamine. Administration of each drug at each dose continued for 30 min and was followed by a 40- to 60-min recovery period. A new baseline was taken before the next drug was administered.

RESULTS

All three drugs significantly increased cardiac index; dopamine by 18%, dobutamine by 48%, and dopexamine by 35%, compared with baseline (P < 0.001 for each). At the same time, superior mesenteric artery flow increased by 33% (P < 0.01) with dopamine and 13% (P < 0.01) with dopexamine, whereas it did not change with dobutamine. Microcirculatory blood flow did not change significantly in any of the organs studied with any of the drugs tested.

CONCLUSION

All the inotropic agents markedly increased cardiac output in this sepsis model. However, increased systemic flow did not reach the microcirculation in the gastrointestinal tract. This may in part explain why some of the clinical trials, in which systemic oxygen delivery was deliberately increased by administration of inotropic drugs, have failed to improve survival in critically ill patients.

摘要

背景

内脏器官血流不足被认为是脓毒性休克后器官功能衰竭发展的一个重要促成因素。有人提出增加全身血流量也可能改善脓毒症患者的内脏血流。本研究的目的是比较三种常用的正性肌力药物多巴胺、多巴酚丁胺和多培沙明对猪脓毒性休克期间全身（心脏指数）、局部（肠系膜上动脉）和局部（微循环）血流的影响。

方法

八只猪静脉麻醉、机械通气，并暴露于粪便性腹膜炎诱导的脓毒症中。用热稀释法测量心脏指数，用超声渡越时间血流仪测量肠系膜上动脉血流，并用六通道激光多普勒血流仪连续测量胃、空肠和结肠黏膜以及肾脏、胰腺和空肠肌层的微循环血流。每只动物按随机顺序、交叉设计依次接受三种受试药物：5和10μg·kg⁻¹·min⁻¹多巴胺、5和10μg·kg⁻¹·min⁻¹多巴酚丁胺以及1和2μg·kg⁻¹·min⁻¹多培沙明。每种药物在每个剂量下持续给药30分钟，随后是40至60分钟的恢复期。在下一种药物给药前获取新的基线值。

结果

与基线相比，所有三种药物均显著增加心脏指数；多巴胺增加18%，多巴酚丁胺增加48%，多培沙明增加35%（每种药物P < 0.001）。同时，多巴胺使肠系膜上动脉血流增加33%（P < 0.01），多培沙明使其增加13%（P < 0.01），而多巴酚丁胺使其无变化。在所研究的任何器官中，用所测试的任何药物均未使微循环血流发生显著变化。