Costello John M, Thiagarajan Ravi R, Dionne Roger E, Allan Catherine K, Booth Karen L, Burmester Margarita, Wessel David L, Laussen Peter C
Division of Cardiac Intensive Care, Department of Cardiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Pediatr Crit Care Med. 2006 Jan;7(1):28-33. doi: 10.1097/01.pcc.0000194046.47306.fb.
Fenoldopam, a selective dopamine-1 receptor agonist, causes systemic vasodilation and increased renal blood flow and tubular sodium excretion. We hypothesized that urine output would improve when fenoldopam was added to conventional diuretic therapy after neonatal cardiopulmonary bypass.
Retrospective cohort study using a time-series design.
Pediatric cardiac intensive care unit.
All neonates who received fenoldopam to promote diuresis after cardiac surgery requiring cardiopulmonary bypass from February 2002 through December 2004.
Fenoldopam infusion for inadequate urine output despite conventional diuretics.
Demographics, diagnostic information, and surgical procedures were recorded. Urine output, fluid balance, inotrope scores, diuretic doses, and other clinical variables that may influence diuresis were recorded for the 24-hr period immediately preceding fenoldopam initiation and during the initial 24 hrs of drug administration.
A total of 25 neonates received fenoldopam to promote diuresis after the modified Norwood (n = 14), arterial switch (n = 4), or other operations (n = 7). Heart rate, conventional diuretic dosing, and fluid intake were similar during the 24-hr periods of conventional therapy and fenoldopam use (p = not significant for all), whereas inotrope scores decreased during the study (p = .021). There was a small but statistically significant increase in blood pressure during the 48-hr study period. Median urine output was 3.6 mL x kg(-1) x hr(-1) (range, 0.2-7.2 mL x kg(-1) x hr(-1)) during the 24-hr period of conventional therapy and 5.8 mL x kg(-1) x hr(-1) (range, 1.6-11.7 mL x kg(-1) x hr(-1)) during the initial 24 hrs of fenoldopam administration (Wilcoxon's signed-rank test, p = .001).
Fenoldopam may improve urine output in neonates who are failing to achieve an adequate negative fluid balance despite conventional diuretic therapy after cardiac surgery and cardiopulmonary bypass. This study is limited by its retrospective design and the possibility that urine output improved spontaneously during the treatment period. A randomized, placebo-controlled clinical trial will be required to confirm these findings.
非诺多泮是一种选择性多巴胺-1受体激动剂，可引起全身血管舒张，增加肾血流量和肾小管钠排泄。我们假设在新生儿体外循环后，将非诺多泮添加到传统利尿治疗中，尿量会增加。
采用时间序列设计的回顾性队列研究。
儿科心脏重症监护病房。
2002年2月至2004年12月期间，所有在心脏手术后接受非诺多泮以促进利尿且需要体外循环的新生儿。
尽管使用了传统利尿剂，但尿量仍不足时输注非诺多泮。
记录人口统计学、诊断信息和手术过程。在开始使用非诺多泮前的24小时以及给药后的最初24小时内，记录尿量、液体平衡、血管活性药物评分、利尿剂剂量以及其他可能影响利尿的临床变量。
共有25例新生儿在改良诺伍德手术（n = 14）、动脉调转术（n = 4）或其他手术（n = 7）后接受非诺多泮以促进利尿。在传统治疗和使用非诺多泮的24小时期间，心率、传统利尿剂剂量和液体摄入量相似（p均无统计学意义），而在研究期间血管活性药物评分降低（p = 0.021）。在48小时的研究期间，血压有小幅但具有统计学意义的升高。在传统治疗的24小时期间，尿量中位数为3.6 mL·kg⁻¹·hr⁻¹（范围为0.2 - 7.2 mL·kg⁻¹·hr⁻¹），在使用非诺多泮的最初24小时内为5.8 mL·kg⁻¹·hr⁻¹（范围为1.6 - 11.7 mL·kg⁻¹·hr⁻¹）（Wilcoxon符号秩检验，p = 0.001）。
对于心脏手术后体外循环且尽管接受传统利尿治疗但仍未实现足够负液体平衡的新生儿，非诺多泮可能会增加尿量。本研究受其回顾性设计的限制，且在治疗期间尿量可能自发改善。需要进行一项随机、安慰剂对照的临床试验来证实这些发现。
