Aronson S, Goldberg L I, Roth S, Glock D, Moss J, Roizen M F
Department of Anesthesia and Critical Care, University of Chicago Hospitals, Illinois 60637.
Can J Anaesth. 1990 Apr;37(3):380-4. doi: 10.1007/BF03005596.
The introduction of drugs that could induce hypotension with different pharmacological actions would be advantageous because side effects unique to a specific drug could be minimized by selecting appropriate therapy. Specific dopamine-1, (DA1) and dopamine-2 (DA2) receptor agonists are now under clinical investigation. Fenoldopam mesylate is a specific DA1 receptor agonist that lowers blood pressure by vasodilatation. The hypothesis that fenoldopam could be used to induce hypotension and preserve blood flow to the kidney was tested. Systemic aortic blood pressure and renal blood flow were measured continuously with a carotid arterial catheter and an electromagnetic flow probe respectively, in order to compare the cardiovascular and renal vascular effects of fenoldopam and sodium nitroprusside in ten dogs under halothane general anaesthesia. Mean arterial pressure was decreased 30 +/- 8 per cent from control with infusion of fenoldopam (3.4 +/- 2.0 micrograms.kg-1.min-1) and 34 +/- 4 per cent with infusion of sodium nitroprusside (5.9 micrograms.kg-1.min-1) (NS). Renal blood flow (RBF) increased during fenoldopam-induced hypotension 11 +/- 7 per cent and decreased 21 +/- 8 per cent during sodium nitroprusside-induced hypotension (P less than 0.01). Sodium nitroprusside is a non-selective arteriolar and venous vasodilator that can produce redistribution of blood flow away from the kidney during induced hypotension. Fenoldopam is a selective dopamine-1 (DA1) receptor agonist that causes vasodilatation to the kidney and other organs with DA1 receptors and preserves blood flow to the kidney during induced hypotension.
引入具有不同药理作用且能诱发低血压的药物会很有益，因为通过选择合适的治疗方法，可以将特定药物特有的副作用降至最低。目前，特异性多巴胺 -1（DA1）和多巴胺 -2（DA2）受体激动剂正在进行临床研究。甲磺酸非诺多泮是一种特异性DA1受体激动剂，可通过血管舒张来降低血压。对非诺多泮可用于诱发低血压并维持肾脏血流这一假说进行了验证。在十只接受氟烷全身麻醉的犬中，分别用颈动脉导管和电磁血流探头连续测量主动脉血压和肾血流量，以比较非诺多泮和硝普钠对心血管和肾血管的影响。输注非诺多泮（3.4±2.0微克·千克⁻¹·分钟⁻¹）时，平均动脉压较对照降低了30±8%；输注硝普钠（5.9微克·千克⁻¹·分钟⁻¹）时，平均动脉压较对照降低了34±4%（无显著性差异）。在非诺多泮诱发低血压期间，肾血流量（RBF）增加了11±7%；而在硝普钠诱发低血压期间，肾血流量减少了21±8%（P＜0.01）。硝普钠是一种非选择性的小动脉和静脉血管扩张剂，在诱发低血压时可导致血流从肾脏重新分布。非诺多泮是一种选择性多巴胺 -1（DA1）受体激动剂，可使肾脏和其他具有DA1受体的器官血管舒张，并在诱发低血压时维持肾脏血流。
