Okamoto R, Yamamoto Y, Lin H, Ueda J, Yokoyama T, Tanaka K, Shimahara Y, Mori K, Kumada K, Yamaoka Y
Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Surgery. 1990 Jan;107(1):36-42.
The influence of dopamine on liver metabolism in the state of brain death was assessed by measuring arterial ketone body ratio (AKBR) in dogs. Mean arterial blood pressure (MABP) was significantly decreased, from 137.4 +/- 3.7 to 64.7 +/- 2.8 mm Hg, 1 hour after completion of brain death (p less than 0.01). In the control group AKBR was maintained at the near control value of 1.07 thereafter, concomitant with a significant decrease in serum lactate levels, despite marked hypotension (p less than 0.05). Dopamine infusion at rates of 5 and 10 micrograms/kg/min sustained both AKBR and MABP at near control values. In contrast, dopamine given at doses greater than 15 micrograms/kg/min caused a significant reduction of AKBR, to less than 0.66 +/- 0.12 (p less than 0.01), although MABP was restored to near-normal levels. In addition, serum levels of alanine aminotransferase, aspartate aminotransferase, and lactate dehydrogenase were significantly elevated, reflecting liver cell injury. It is suggested that the liver is primarily tolerant to hypotension in the state of brain death and that dopamine administered at a rate of 15 micrograms/kg/min or more impairs liver metabolism by reducing the redox state (free nicotinamide-adenine dinucleotide/reduced nicotinamide-adenine dinucleotide) of liver mitochondria.
通过测量犬的动脉酮体比率（AKBR）来评估多巴胺对脑死亡状态下肝脏代谢的影响。脑死亡完成1小时后，平均动脉血压（MABP）显著下降，从137.4±3.7毫米汞柱降至64.7±2.8毫米汞柱（p<0.01）。在对照组中，此后AKBR维持在接近1.07的对照值，同时血清乳酸水平显著下降，尽管存在明显低血压（p<0.05）。以5和10微克/千克/分钟的速率输注多巴胺可使AKBR和MABP维持在接近对照值的水平。相比之下，以大于15微克/千克/分钟的剂量给予多巴胺会导致AKBR显著降低，降至小于0.66±0.12（p<0.01），尽管MABP恢复到接近正常水平。此外，血清丙氨酸转氨酶、天冬氨酸转氨酶和乳酸脱氢酶水平显著升高，反映了肝细胞损伤。提示在脑死亡状态下肝脏对低血压具有主要耐受性，且以15微克/千克/分钟或更高速率给予多巴胺会通过降低肝线粒体的氧化还原状态（游离烟酰胺腺嘌呤二核苷酸/还原型烟酰胺腺嘌呤二核苷酸）损害肝脏代谢。
