Bataille Aurélien, Payen Didier, Villiers Stéphane, Chazalet Jean-Jacques, Jacob Laurent
From the Department of Anesthesia and Intensive Care, Groupe Hospitalier Universitaire Saint-Louis-Lariboisière-Fernand-Widal, Assistance Publique-Hôpitaux de Paris, 75010, France.
Exp Clin Transplant. 2016 Apr;14(2):176-83. doi: 10.6002/ect.2015.0181. Epub 2016 Jan 14.
The relation between dopamine infusion and renal hemodynamics and function has not been studied in renal allografts during early recovery. We analyzed the dose response of dopamine infusion on renal blood flow and function in human kidney transplant recipients at reperfusion and during early graft recovery.
Phasic and mean renal blood flow was measured by the pulsed Doppler technique using implantable Doppler microprobes in contact with the graft artery. Systemic and renal parameters were recorded on dopamine infusion (0, 3, 5, and 10 μg·kg⁻¹·min⁻¹) immediately after transplant (day 0) in 13 patients and at day 6 in 7/13 patients with early graft recovery. Results are expressed as median and interquartile range between the 25th and 75th percentiles.
At day 0, 3 μg·kg⁻¹·min⁻¹) dopamine did not increase mean renal blood flow over baseline (580 mL/min [219-663 mL/min] vs 542 mL/min [207-686 mL/min]; P = .84). There was an absence of effect with higher dopamine doses, whereas cardiac output, heart rate, and systolic and mean arterial pressure were significantly increased. Urinary sodium excretion, creatinine clearance, and urine output increased dose dependently, with a positive correlation between the increase in urine output and mean arterial pressure (r = 0.48, P < .001). At day 6, 3 μg·kg⁻¹·min⁻¹ dopamine increased mean renal blood flow over baseline (318 mL/min [234-897 mL/min] vs 191 mL/min [173-706 mL/min]; P = .016), with no further increase at higher doses.
Immediately after transplant, kidney grafts with ischemic-reperfusion injury are fully dilated and do not respond to dopamine. The specific renal effects observed are due to systemic hemodynamic status. Vascular responsiveness to a "renal dopamine dose" returns on graft recovery.
早期恢复阶段肾移植中多巴胺输注与肾脏血流动力学及功能之间的关系尚未得到研究。我们分析了多巴胺输注对人肾移植受者再灌注时及移植肾早期恢复阶段肾脏血流和功能的剂量反应。
使用植入式多普勒微探头与移植肾动脉接触，通过脉冲多普勒技术测量阶段性和平均肾血流。在13例患者移植后即刻（第0天）以及7/13例移植肾早期恢复患者的第6天，记录多巴胺输注（0、3、5和10μg·kg⁻¹·min⁻¹）时的全身和肾脏参数。结果以第25百分位数和第75百分位数之间的中位数和四分位数间距表示。
在第0天，3μg·kg⁻¹·min⁻¹的多巴胺未使平均肾血流超过基线水平（分别为580 mL/min [219 - 663 mL/min]和542 mL/min [207 - 686 mL/min]；P = 0.84）。更高剂量的多巴胺也无效果，而心输出量、心率以及收缩压和平均动脉压显著升高。尿钠排泄、肌酐清除率和尿量呈剂量依赖性增加，尿量增加与平均动脉压之间呈正相关（r = 0.48，P < 0.001）。在第6天，3μg·kg⁻¹·min⁻¹的多巴胺使平均肾血流超过基线水平（分别为318 mL/min [234 - 897 mL/min]和191 mL/min [173 - 706 mL/min]；P = 0.016），更高剂量时无进一步增加。
移植后即刻，存在缺血再灌注损伤的移植肾血管已充分扩张，对多巴胺无反应。观察到的特定肾脏效应归因于全身血流动力学状态。移植肾恢复后对“肾脏多巴胺剂量”的血管反应性恢复。
