Loomba Rohit S, Patel Riddhi D, Villarreal Enrique G, Farias Juan S, Flores Saul
Division of Pediatric Cardiac Critical Care (RSL, RDP), Advocate Children's Hospital, Oak Lawn, IL.
Department of Pediatrics (RSL), Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL.
J Pediatr Pharmacol Ther. 2024 Dec;29(6):578-586. doi: 10.5863/1551-6776-29.6.578. Epub 2024 Dec 9.
Pediatric patients often receive vasoactive agents following cardiothoracic surgery or when in shock. The use of vasoactive agents varies between different settings and has largely changed because of anecdotal observations or small observational studies. Although vasoactive agents are frequently used, there are limited studies in pediatric populations comparing them to one another. The purpose of this systematic review is to quantify the comparative effects of epinephrine and dopamine while identifying gaps in knowledge.
A systematic review of published manuscripts was completed to identify full-text manuscripts in English using PubMed, Embase, and Cochrane databases. Studies were included if they included clinical data using dopamine and epinephrine in different patients and included data for the same end points for patients receiving epinephrine or dopamine.
A total of 5 studies with 397 patients were included. Of the included patients, 187 received epinephrine and 210 received dopamine. The mean age for all the patients was 45 months. When all patient data were pooled, a significantly lower mortality was associated with epinephrine compared with dopamine (risk ratio, 0.74; 95% CI, 0.55-0.99). When only neonatal data were pooled, epinephrine was associated with a significantly higher average heart rate (10 bpm; 95% CI, 2.0-18.7) and a significantly lower average mean arterial blood pressure (-2.5 mm Hg; 95% CI, -4.6 to -0.4).
Limited data are available comparing dopamine to epinephrine in pediatric patients. The -available data demonstrate an apparent mortality benefit associated with the use of epinephrine.
小儿患者在心胸外科手术后或休克时经常接受血管活性药物治疗。血管活性药物的使用在不同情况下有所不同，并且由于轶事观察或小型观察性研究，其使用情况已发生很大变化。尽管血管活性药物经常被使用，但在儿科人群中比较它们之间效果的研究有限。本系统评价的目的是量化肾上腺素和多巴胺的比较效果，同时找出知识空白。
完成了对已发表手稿的系统评价，以使用PubMed、Embase和Cochrane数据库识别英文全文手稿。如果研究包括在不同患者中使用多巴胺和肾上腺素的临床数据，并且包括接受肾上腺素或多巴胺的患者相同终点的数据，则纳入研究。
共纳入5项研究，397例患者。在纳入的患者中，187例接受肾上腺素，210例接受多巴胺。所有患者的平均年龄为45个月。当汇总所有患者数据时，与多巴胺相比，肾上腺素相关的死亡率显著降低（风险比，0.74；95%CI，0.55-0.99）。仅汇总新生儿数据时，肾上腺素与显著更高的平均心率（10次/分钟；95%CI，2.0-18.7）和显著更低的平均动脉血压（-2.5 mmHg；95%CI，-4.6至-0.4）相关。
在儿科患者中比较多巴胺和肾上腺素的数据有限。现有数据表明使用肾上腺素具有明显的死亡率益处。
