Davis R F, Lappas D G, Kirklin J K, Buckley M J, Lowenstein E
Crit Care Med. 1982 Dec;10(12):852-6.
Hemodynamic and renal function response to low-dose (100 and 200 micrograms/min) dopamine infusion was studied in 15 adult cardiac surgical patients who manifested combined oliguria and left ventricular dysfunction postoperatively. Patients were studied an average of 6.6 h after ICU admission, at normothermia and after 2 consecutive hourly urine output determinations of less than 0.5 ml/kg . h in the presence of a left atrial or pulmonary artery occlusion pressure over 12 mm Hg. Dopamine infusion at 100 micrograms/min produced improvement in creatinine, osmolar and free water clearances (70 +/- 10 to 115 +/- 13, 37 +/- 4 to 93 +/- 16 and --15 +/- 2 to --37 +/- 10 ml/min, respectively), and urinary sodium concentration (15 +/- 5 to 29 +/- 10 mEq/L). Urine flow improved overall from 22 +/- 2 to 54 +/- 9 ml/h; however, in 9 of 15 patients, flow was less than 0.5 ml/kg . h (33 +/- 5 to 50 +/- 6 ml/h). In each of these 9 patients, dopamine infusion at 20 micrograms/min further improved urine flow as well as measured renal function. Plasma renin activity measured in 9 of the 15 patients before and during the 100 micrograms/min dopamine infusion was decreased from 1.95 +/- 0.57 to 0.73 +/- 0.39 ng/ml . h. The hemodynamic effect of both dopamine doses was increased cardiac output coupled with decreased systemic (SVRI) and pulmonary vascular resistance index (PVRI). In these 15 patients, low-dose dopamine infusion produced significant improvement in renal function, with resolution of oliguria in every case, and with no deleterious hemodynamic effect.
对15例术后出现少尿合并左心室功能障碍的成年心脏手术患者，研究了小剂量（100和200微克/分钟）多巴胺输注对血流动力学和肾功能的影响。患者在入住重症监护病房平均6.6小时后进行研究，此时体温正常，且在左心房或肺动脉闭塞压超过12毫米汞柱的情况下，连续2小时每小时尿量测定均小于0.5毫升/千克·小时。以100微克/分钟的速度输注多巴胺后，肌酐清除率、渗透压清除率和自由水清除率分别从70±10提高到115±13、37±4提高到93±16、-15±2提高到-37±10毫升/分钟，尿钠浓度从15±5提高到29±10毫当量/升。总体尿量从22±2提高到54±9毫升/小时；然而，15例患者中有9例尿量仍小于0.5毫升/千克·小时（从33±5提高到50±6毫升/小时）。在这9例患者中，以20微克/分钟的速度输注多巴胺进一步改善了尿量及测定的肾功能。在15例患者中的9例于100微克/分钟多巴胺输注前及输注期间测定血浆肾素活性，其从1.95±0.57降至0.73±0.39纳克/毫升·小时。两种剂量多巴胺的血流动力学效应均为增加心输出量，同时降低全身血管阻力指数（SVRI）和肺血管阻力指数（PVRI）。在这15例患者中，小剂量多巴胺输注使肾功能显著改善，所有病例少尿均得到缓解，且无有害的血流动力学效应。
