Gastroenterology Department, Puerta del Mar University Hospital, Cadiz, Spain.
J Gastrointestin Liver Dis. 2011 Jun;20(2):161-7.
Acute renal failure is a relevant complication in obstructive jaundice (OJ). The extracellular water volume (ECW) depletion and myocardial dysfunction affects haemodynamic and renal disturbance in patients with OJ.
A prospective open randomised study was conducted to evaluate the effect of peridrainage saline infusion associated with dopamine administration on hormonal and renal function derangements in 102 patients with malignant OJ. Patients were randomly distributed according to whether (n=64) or not (n=38) received dopamine with saline solution before endoscopic biliary drainage. Furthermore, patients receiving dopamine were randomly distributed whether (n=31) or not (n=33) received additional dopamine administration during the postdrainage phase. Different parameters such as ECW, serum levels of aldosterone, renin, atrial natriuretic peptide (ANP), antidiuretic hormone (ADH), endothelin-1 (ET-1), urine PGE2 and creatinine clearance (CrCl) were analyzed.
Fluid administration was accompanied by an increase in the ECW (p=0.01) and an improvement in the CrCl (p=0.01). Dopamine increased CrCl by 11% (p=0.04) and reduced urinary PGE2 concentration (p=0.02). After drainage, a transient worsening of CrCl was seen in patients on i.v. fluid infusion alone but not in dopamine groups (p=0.001). Improvement of CrCl after dopamine administration was found in patients with serum bilirubin > 16 mg/dl and sodium urine excretion <145 mEq/l.
The administration of dopamine associated with appropriate i.v. fluid infusion in the peridrainage period has an impact on renal function only in selected patients with malignant biliary obstruction. This effect is more relevant in patients with higher marked cholestasis.
急性肾衰竭是阻塞性黄疸（OJ）的一种相关并发症。细胞外液体积（ECW）耗竭和心肌功能障碍会影响 OJ 患者的血液动力学和肾功能紊乱。
进行了一项前瞻性开放随机研究，以评估引流期间输注生理盐水联合多巴胺对 102 例恶性 OJ 患者激素和肾功能紊乱的影响。根据患者是否接受（n=64）或不接受（n=38）内镜胆道引流前的多巴胺加生理盐水溶液，将患者随机分组。此外，接受多巴胺的患者根据是否（n=31）或不（n=33）在引流后阶段接受额外的多巴胺给药而随机分组。分析了不同的参数，如 ECW、醛固酮、肾素、心房利钠肽（ANP）、抗利尿激素（ADH）、内皮素-1（ET-1）、尿 PGE2 和肌酐清除率（CrCl）。
液体输注伴随 ECW 增加（p=0.01）和 CrCl 改善（p=0.01）。多巴胺使 CrCl 增加了 11%（p=0.04）并降低了尿 PGE2 浓度（p=0.02）。在单独接受静脉输液的患者中，引流后 CrCl 短暂恶化，但在多巴胺组中没有（p=0.001）。在血清胆红素>16mg/dl 和尿钠排泄<145mEq/l 的患者中，发现多巴胺给药后 CrCl 改善。
在引流期间，多巴胺联合适当的静脉输液仅对选定的恶性胆道梗阻患者的肾功能有影响。这种作用在具有更高标记性胆汁淤积的患者中更为相关。
