Department of Pediatrics, School of Medicine, University of Maryland Baltimore, Baltimore, MD, USA.
Pediatr Res. 2020 Oct;88(4):618-622. doi: 10.1038/s41390-020-0790-0. Epub 2020 Jan 31.
To test the hypothesis that dopamine is associated with impaired cerebral autoregulation (ICA) in a dose-dependent fashion.
Non a priori designed secondary analysis of a prospectively enrolled cohort study subjects <12 h of life between 24 and 29 weeks gestation. Cerebral saturations (rScO2) and mean arterial blood pressure (MAP) were continuously monitored every 30 s for 96 h. ICA was defined by a 10 min epoch rScO2-MAP correlation coefficient of >0.5.
Twenty-three of 61 subjects (38%) required dopamine. Time spent with ICA was 23% in dopamine-exposed subjects vs. 14% in those not exposed (p = 0.0001). On the epoch level, time spent with ICA was 15%, 29%, 34%, 37%, and 23% in epochs with dopamine titration of 0, 1-5, 6-10, 11-15, and 16-20 μg/kg/min, respectively. Using mixed-effect modeling, ICA for each dopamine titration was significantly higher than unexposed times when controlling for gestation, presence of a patent ductus arteriosus, day of life, MAP less than gestational age, and illness severity score (p < 0.02).
Dopamine exposure during the first 96 h was associated with ICA. Time periods with ICA increased with dopamine exposure in a dose-dependent fashion peaking at a concentration of 11-15 μg/kg/min.
为了验证多巴胺与脑自动调节功能障碍（ICA）呈剂量依赖性相关的假设。
对 24-29 孕周、生命时间<12 小时的前瞻性队列研究受试者进行非预设的二级分析。连续监测脑饱和度（rScO2）和平均动脉血压（MAP），每 30 秒监测 96 小时。ICA 定义为 rScO2-MAP 相关系数>0.5 的 10 分钟时相。
61 例患儿中有 23 例（38%）需要多巴胺。ICA 时间在多巴胺暴露组中占 23%，而非暴露组中占 14%（p=0.0001）。在时相水平上，多巴胺滴定分别为 0、1-5、6-10、11-15 和 16-20μg/kg/min 时，ICA 时间分别为 15%、29%、34%、37%和 23%。使用混合效应模型，在控制胎龄、动脉导管未闭、生命天数、MAP 低于胎龄和疾病严重程度评分的情况下，每个多巴胺滴定的 ICA 均显著高于未暴露时间（p<0.02）。
出生后前 96 小时的多巴胺暴露与 ICA 相关。随着多巴胺暴露剂量的增加，ICA 时间呈剂量依赖性增加，在 11-15μg/kg/min 时达到峰值。
