Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Department of Pediatrics, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Perinatol. 2011 Oct;31(10):647-55. doi: 10.1038/jp.2011.2. Epub 2011 Jan 27.
Dopamine administration results in variable effects on blood pressure in hypotensive preterm infants. The clinical benefits of dopamine administration in increasing cerebral blood flow (CBF) and reducing adverse neurological outcomes in hypotensive preterm neonates are unclear. The objective of this study was to examine the efficacy of dopamine for treatment of hypotension and investigate the changes in cerebral hemodynamics and central nervous system injury in hypotensive preterm infants following dopamine administration.
Standard meta-analytic techniques, including random and fixed effects models, were used to calculate combined effect size correlations and significance levels.
Random effects meta-analysis found that dopamine increases mean arterial blood pressure (12 studies; N=163; r=0.88, 95% confidence interval (CI)=0.76 to 0.94) and systolic blood pressure (8 studies; N=142; r=0.81, 95% CI=0.42 to 0.94). For the increase in blood pressure, dopamine administration was associated with a significantly greater overall efficacy than dobutamine (seven studies; N=251; r=0.26; 95% CI=0.20 to 0.32), colloid (two studies; N=67; r=0.60; 95% CI=0.41 to 0.74) and hydrocortisone (one study; N=28; r=0.40; 95% CI=0.034 to 0.67). CBF increased following dopamine administration (five studies; N=75; r=0.36; 95% CI=-0.059 to 0.67) and the increase in CBF was greater in hypotensive than normotensive preterm infants (eight studies; N=153; r=0.16; 95% CI=-0.0080 to 0.32). There were no statistically significant differences in adverse neurological outcome between dopamine and dobutamine (three studies; N=118; r=-0.13; 95% CI=-0.31 to 0.059), epinephrine (two studies; N=46; r=0.06; 95% CI=-0.23 to 0.34), colloid (two studies; N=80; r=0.0070; 95% CI=-0.218 to 0.23) or hydrocortisone administration (one study; N=40; r=-0.10; 95% CI=-0.40 to 0.22).
Dopamine administration increases mean and systolic blood pressure in hypotensive preterm infants, and is more effective than dobutamine, colloid or hydrocortisone alone. Dopamine administration is associated with increased CBF, with greater increases in CBF in hypotensive than in normotensive preterm infants. Dopamine is not associated with a greater incidence of adverse effects than other therapies used to treat hypotension.
多巴胺的使用会导致低血压早产儿的血压出现不同的变化。在低血压早产儿中，多巴胺在增加脑血流量（CBF）和降低不良神经结局方面的临床获益尚不清楚。本研究旨在检查多巴胺治疗低血压的疗效，并探讨多巴胺治疗后低血压早产儿的脑血流动力学和中枢神经系统损伤的变化。
使用标准荟萃分析技术，包括随机和固定效应模型，计算合并效应大小相关性和显著性水平。
随机效应荟萃分析发现，多巴胺可升高平均动脉血压（12 项研究；N=163；r=0.88，95%置信区间（CI）=0.76 至 0.94）和收缩压（8 项研究；N=142；r=0.81，95%CI=0.42 至 0.94）。在血压升高方面，多巴胺的治疗效果明显优于多巴酚丁胺（7 项研究；N=251；r=0.26；95%CI=0.20 至 0.32）、胶体（2 项研究；N=67；r=0.60；95%CI=0.41 至 0.74）和氢化可的松（1 项研究；N=28；r=0.40；95%CI=0.034 至 0.67）。多巴胺治疗后 CBF 增加（5 项研究；N=75；r=0.36；95%CI=-0.059 至 0.67），在低血压早产儿中 CBF 的增加大于正常血压早产儿（8 项研究；N=153；r=0.16；95%CI=-0.0080 至 0.32）。多巴胺与多巴酚丁胺（3 项研究；N=118；r=-0.13；95%CI=-0.31 至 0.059）、肾上腺素（2 项研究；N=46；r=0.06；95%CI=-0.23 至 0.34）、胶体（2 项研究；N=80；r=0.0070；95%CI=-0.218 至 0.23）或氢化可的松（1 项研究；N=40；r=-0.10；95%CI=-0.40 至 0.22）之间在不良神经结局方面无统计学差异。
多巴胺可增加低血压早产儿的平均动脉压和收缩压，且比多巴酚丁胺、胶体或氢化可的松单独使用更有效。多巴胺治疗与 CBF 增加相关，在低血压早产儿中 CBF 增加幅度大于正常血压早产儿。与其他用于治疗低血压的治疗方法相比，多巴胺治疗与更高的不良反应发生率无关。
