Piepenbrock S, Hempelmann G, Reichelt W, Stegmann T
Anaesthesist. 1979 Jul;28(7):307-15.
In cardiosurgical patients the haemodynamic effects of dobutamine 2.5 microgram/kg . min and 5 microgram/kg . min dobutamine were investigated during neuroleptanalgesia, intra- and immediately postoperatively. Intraoperative measurements were performed in 8 coronary surgical patients each after sternotomy and pericardiotomy, but before the aortocoronary venous bypass operation. The following haemodynamic parameters increased significantly: cardiac index (2.5 microgram/kg . min: 2.6 leads to 2.1 1/min . m2; 6 microgram/kg . min: 1.5 leads to 2.24 1/min . m2), heart rate (80 leads to 91 min-1; 86 leads to 107 min-1), stroke index (16%, 27%), mean arterial pressure (70 leads to 90 mm Hg; 70 leads to 93 mm Hg), mean pulmonary arterial pressure (8%; 14%), LV dp/dtmax (72%; 121%) and calculated myocardial oxygen consumption Eg (35%; 52%). Changes in right (PRA) and left ventricular filling pressure (PLVED), in total systemic resistance and total pulmonary vascular resistance were not significant. Postoperative measurement immediately after open heart operations (ASD-correction n = 5, aortocoronary venous bypass (n = 3) in neuroleptanalgesia too, showed the same haemodynamic results as intraoperatively before correction of coronary stenosis. Only a few premature ventricular beats were observed in 3 patients and there were no changes in S-T segments during dobutamine infusion. In another group of 15 patients selective vascular responses to an infusion of 10 microgram/kg . min dobutamine were examined during steady state cardiopulmonary bypass excluding heart and lungs from the circulation. No relevant direct influence on the arteriolar resistance vessels and the venous capacitance vessels were found. In a dose range of 2.5--5.0 microgram/kg . min dobutamine proved to be a potent inotropic agent causing almost no peripheral and relatively little positive chronotropic effects. But the increase in heart rate was more pronounced than in other clinical investigations in conscious patients, which might be due to an attenuation of vagal reflex by anaesthesia. The results indicate, that dobutamine may be a valuable drug in the treatment of intra- and postoperative low output syndromes especially in patients with coronary heart disease.
在心脏外科手术患者中，研究了在神经安定镇痛期间、术中及术后即刻，给予2.5微克/千克·分钟和5微克/千克·分钟多巴酚丁胺的血流动力学效应。对8例冠状动脉手术患者在胸骨切开术和心包切开术后、但在主动脉冠状动脉静脉搭桥手术前进行术中测量。以下血流动力学参数显著增加：心脏指数（2.5微克/千克·分钟：从2.6升至2.1升/分钟·平方米；6微克/千克·分钟：从1.5升至2.24升/分钟·平方米）、心率（从80升至91次/分钟；从86升至107次/分钟）、每搏指数（16%，27%）、平均动脉压（从70升至90毫米汞柱；从70升至93毫米汞柱）、平均肺动脉压（8%；14%）、左心室dp/dtmax（72%；121%）以及计算得出的心肌氧耗量Eg（35%；52%）。右心室（PRA）和左心室充盈压（PLVED）、总全身阻力和总肺血管阻力的变化不显著。心脏直视手术后即刻（房间隔缺损修复术n = 5，主动脉冠状动脉静脉搭桥术（n = 3）也在神经安定镇痛下进行）的术后测量显示，与冠状动脉狭窄纠正术前术中的血流动力学结果相同。仅在3例患者中观察到少数室性早搏，多巴酚丁胺输注期间S-T段无变化。在另一组15例患者中，在心肺转流稳态期间，排除心脏和肺参与循环，研究了对输注10微克/千克·分钟多巴酚丁胺的选择性血管反应。未发现对小动脉阻力血管和静脉容量血管有相关直接影响。在2.5 - 5.0微克/千克·分钟的剂量范围内，多巴酚丁胺被证明是一种有效的强心剂，几乎不引起外周效应，正性变时作用相对较小。但心率的增加比清醒患者的其他临床研究中更明显，这可能是由于麻醉减弱了迷走反射。结果表明，多巴酚丁胺可能是治疗术中及术后低输出综合征的一种有价值的药物，尤其是在冠心病患者中。
