Kwapisz Myron M, Neuhäuser Christoph, Scholz Stephan, Welters Ingeborg D, Löhr Tobias, Koch Tillo, Valeske Klaus, Akintürk Hakan, Thul Josef, Müller Matthias
Department of Anesthesia, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada.
Paediatr Anaesth. 2009 Sep;19(9):862-71. doi: 10.1111/j.1460-9592.2009.03101.x. Epub 2009 Jul 24.
After surgical repair of congenital heart disease, inotropic support is sometimes necessary to wean from cardiopulmonary bypass. In pediatric cardiac surgery, dobutamine and dopamine are often used as inotropic support. Dopexamine is a synthetic catecholamine, which has positive inotropic and vasodilating properties. Because the hemodynamic effects of catecholamines are modified after cardiopulmonary bypass, the aim of this study was to investigate the effects of dobutamine and dopexamine on cardiac index and systemic vascular resistance index after cardiopulmonary bypass in pediatric cardiac surgery.
The study was performed in a prospective, randomized, and double-blinded cross-over design. The investigation included 11 children for elective, noncomplex congenital heart surgery. After weaning from cardiopulmonary bypass and a 20-min period of steady state, children received either 2.5 microg x kg(-1) x min(-1) dobutamine or 1 microg x kg(-1) x min(-1) dopexamine for 20 min. Cardiac index (transpulmonary thermodilution), mean arterial pressure, central venous pressure, stroke volume, systemic vascular resistance, and central venous oxygen saturation were determined. The primary outcome variable was cardiac index.
No difference in cardiac index was observed between the two groups (P = 0.594). Both drugs increased cardiac index, dopexamine from 3.9 +/- 0.6 to 4.7 +/- 0.8 l x min(-1) x m(-2) (P = 0.003) and dobutamine from 4.1 +/- 0.7 to 4.8 +/- 0.7 l x min(-1) x m(-2) (P = 0.004). During treatment with dobutamine, children presented with significantly higher mean arterial pressure (P = 0.003) and systemic vascular resistance index (P = 0.026).
This trial demonstrates that low-dose dobutamine and dopexamine both increase cardiac index during pediatric cardiac surgery but with different hemodynamic effects.
先天性心脏病手术修复后，有时需要使用正性肌力药物支持以脱离体外循环。在小儿心脏手术中，多巴酚丁胺和多巴胺常被用作正性肌力支持药物。多培沙明是一种合成儿茶酚胺，具有正性肌力和血管舒张特性。由于体外循环后儿茶酚胺的血流动力学效应会发生改变，本研究的目的是探讨多巴酚丁胺和多培沙明对小儿心脏手术体外循环后心脏指数和全身血管阻力指数的影响。
本研究采用前瞻性、随机、双盲交叉设计。研究纳入了11名择期进行非复杂性先天性心脏病手术的儿童。在脱离体外循环并经过20分钟的稳定期后，儿童接受2.5微克/千克(-1)·分钟(-1)的多巴酚丁胺或1微克/千克(-1)·分钟(-1)的多培沙明治疗20分钟。测定心脏指数（经肺热稀释法）、平均动脉压、中心静脉压、每搏量、全身血管阻力和中心静脉血氧饱和度。主要结局变量是心脏指数。
两组之间心脏指数无差异（P = 0.594）。两种药物均增加了心脏指数，多培沙明使心脏指数从3.9±0.6升高至4.7±0.8升/分钟·米(-2)（P = 0.003），多巴酚丁胺使心脏指数从4.1±0.7升高至4.8±0.7升/分钟·米(-2)（P = 0.004）。在多巴酚丁胺治疗期间，儿童的平均动脉压（P = 0.003）和全身血管阻力指数（P = 0.026）显著更高。
本试验表明，低剂量多巴酚丁胺和多培沙明在小儿心脏手术期间均能增加心脏指数，但血流动力学效应不同。
