Al-Hesayen Abdul, Parker John D
Department of Medicine, Division of Cardiology, St. Michael's Hospital, Canada.
J Cardiovasc Pharmacol. 2008 May;51(5):434-6. doi: 10.1097/FJC.0b013e3181684026.
The pathophysiology of the cardiorenal syndrome remains poorly understood. Renal sympathetic activity is increased in heart failure. It contributes to the sodium avid state, renal vasoconstriction, and reduced glomerular filtration rate that is characteristic of a large number of heart failure patients. Dobutamine is commonly used in the treatment of decompensated heart failure. We used the norepinephrine spillover technique to examine the effects of dobutamine on renal sympathetic activity in human heart failure. Dobutamine was titrated to increase the peak positive rate of change in left ventricular pressure by 25%. In 11 patients with heart failure, dobutamine infusion reduced efferent renal sympathetic activity by 50% (P < 0.003). This sympatholytic response was associated with an 11% increase in renal plasma flow (P < 0.03) and a 12% increase in glomerular filtration rate (P < 0.04). These findings suggest that dobutamine infusion is acutely associated with a beneficial effect on renal function. This observation is potentially related to a renal sympatholytic response to ventricular mechanoreceptor activation associated with the inotropic effects of beta-adrenergic receptor stimulation.
心肾综合征的病理生理学仍未被充分理解。心力衰竭时肾交感神经活动增强。它导致钠潴留状态、肾血管收缩以及大量心力衰竭患者所特有的肾小球滤过率降低。多巴酚丁胺常用于治疗失代偿性心力衰竭。我们采用去甲肾上腺素溢出技术来研究多巴酚丁胺对人类心力衰竭患者肾交感神经活动的影响。将多巴酚丁胺滴定至使左心室压力变化的峰值阳性率增加25%。在11例心力衰竭患者中，输注多巴酚丁胺使肾传出交感神经活动降低了50%（P < 0.003）。这种交感神经抑制反应与肾血浆流量增加11%（P < 0.03）以及肾小球滤过率增加12%（P < 0.04）相关。这些发现表明，输注多巴酚丁胺与对肾功能的有益作用急性相关。这一观察结果可能与心室机械感受器激活所引发的肾交感神经抑制反应有关，而心室机械感受器激活与β - 肾上腺素能受体刺激的正性肌力作用相关。
