Cátedras de Terapia Intensiva y Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, 60 y 120, La Plata B1902AGW, Argentina.
Sanatorio Otamendi, Azcuénaga 870, Ciudad Autónoma de Buenos Aires C1115AAB, Argentina.
Medicina (Kaunas). 2024 Apr 30;60(5):751. doi: 10.3390/medicina60050751.
The key objective in the hemodynamic treatment of septic shock is the optimization of tissue perfusion and oxygenation. This is usually achieved by the utilization of fluids, vasopressors, and inotropes. Dobutamine is the inotrope most commonly recommended and used for this purpose. Despite the fact that dobutamine was introduced almost half a century ago in the treatment of septic shock, and there is widespread use of the drug, several aspects of its pharmacodynamics remain poorly understood. In normal subjects, dobutamine increases contractility and lacks a direct effect on vascular tone. This results in augmented cardiac output and blood pressure, with reflex reduction in systemic vascular resistance. In septic shock, some experimental and clinical research suggest beneficial effects on systemic and regional perfusion. Nevertheless, other studies found heterogeneous and unpredictable effects with frequent side effects. In this narrative review, we discuss the pharmacodynamic characteristics of dobutamine and its physiologic actions in different settings, with special reference to septic shock. We discuss studies showing that dobutamine frequently induces tachycardia and vasodilation, without positive actions on contractility. Since untoward effects are often found and therapeutic benefits are occasional, its profile of efficacy and safety seems low. Therefore, we recommend that the use of dobutamine in septic shock should be cautious. Before a final decision about its prescription, efficacy, and tolerance should be evaluated throughout a short period with narrow monitoring of its wanted and side effects.
在感染性休克的血流动力学治疗中，关键目标是优化组织灌注和氧合。这通常通过液体、血管加压药和正性肌力药的应用来实现。多巴酚丁胺是最常被推荐和用于此目的的正性肌力药。尽管多巴酚丁胺在感染性休克的治疗中已经使用了近半个世纪，而且该药物的应用广泛，但它的一些药效学方面仍然知之甚少。在正常受试者中，多巴酚丁胺增加心肌收缩力，并且对血管张力没有直接作用。这导致心输出量和血压增加，同时反射性降低全身血管阻力。在感染性休克中，一些实验和临床研究表明它对全身和局部灌注有有益的影响。然而，其他研究发现存在异质性和不可预测的影响，且常伴有副作用。在这篇叙述性综述中，我们讨论了多巴酚丁胺的药效学特征及其在不同情况下的生理作用，特别参考了感染性休克。我们讨论了一些研究表明，多巴酚丁胺常引起心动过速和血管扩张，而对收缩力没有积极作用。由于经常发现不良影响，且治疗益处偶发，因此其疗效和安全性特征似乎较低。因此，我们建议在感染性休克中使用多巴酚丁胺应谨慎。在决定其处方、疗效和耐受性之前，应通过密切监测其预期和副作用，在短时间内进行评估。
