Maynard N D, Bihari D J, Dalton R N, Smithies M N, Mason R C
Department of Surgery, Guy's Hospital, London, United Kingdom.
Chest. 1995 Dec;108(6):1648-54. doi: 10.1378/chest.108.6.1648.
To assess the effect of low dose dopexamine and dopamine on splanchnic blood flow as measured by gastric intramucosal pH, hepatic metabolism of lidocaine (lignocaine) to monoethylglycinexy-lidide (MEGX), and plasma disappearance rate of indocyanine green (ICG).
Single-blind randomization of patients with a gastric intramucosal acidosis to receive dopexamine (ten patients), dopamine (ten patients), or saline solution (five control patients) for 2 h.
All 25 patients were in the ICU of Guys' Hospital.
All patients met the criteria for the diagnosis of the systemic inflammatory response syndrome, were mechanically ventilated, and had pulmonary artery catheters placed. All had a low gastric intramucosal pH and had a median first 24-h acute physiology and chronic health evaluation (II) score of 22 (range, 7 to 40).
Baseline measurements of gastric intramucosal pH, MEGX formation from lidocaine, ICG plasma disappearance rate, heart rate, mean arterial pressure, pulmonary artery occlusion pressure, cardiac index, oxygen delivery index, oxygen uptake index, systemic vascular resistance, and arterial pH were taken. Dopexamine (1 mg.kg-1.min-1), dopamine (2.5 mg.kg-1.min-1), or 0.9% saline solution was then infused for 2 h, after which a repeated set of the measurements was taken.
Dopexamine at a low dose had no effect on any of the systemic measurements. The median intramucosal pH rose from 7.23 to 7.35 (p < 0.005), the median ICG plasma disappearance rate from 7.6 to 11.3%.min-1 (p < 0.02), and the median MEGX concentration from 4 to 10.2 ng.mL-1 (p < 0.005). Dopamine had no effect on any of the measured variables. There were no changes in the control group.
Low-dose dopexamine increases splanchnic blood flow as measured by gastric intramucosal pH, MEGX formation from lidocaine, and ICG clearance. The lack of any change in the systemic measurements suggests that these effects are the result of a selective vasodilatation of the splanchnic vessels. At the dose used in this study, dopamine had no effect on splanchnic blood flow. Dopexamine may be useful in the management of splanchnic ischemia in the critically ill.
通过胃黏膜内pH值、利多卡因（昔罗卡因）向单乙基甘氨酰二甲苯卡因（MEGX）的肝脏代谢以及吲哚菁绿（ICG）的血浆消失率来评估低剂量多培沙明和多巴胺对内脏血流的影响。
对胃黏膜内酸中毒患者进行单盲随机分组，分别给予多培沙明（10例患者）、多巴胺（10例患者）或生理盐水（5例对照患者），持续2小时。
所有25例患者均在盖伊医院重症监护病房。
所有患者均符合全身炎症反应综合征的诊断标准，接受机械通气，且均放置了肺动脉导管。所有患者胃黏膜内pH值均较低，急性生理与慢性健康状况评分系统（II）前24小时中位数为22分（范围7至40分）。
测量胃黏膜内pH值、利多卡因生成MEGX、ICG血浆消失率、心率、平均动脉压、肺动脉闭塞压、心脏指数、氧输送指数、氧摄取指数、全身血管阻力和动脉pH值的基线值。然后分别输注多培沙明（1毫克·千克-1·分钟-1）、多巴胺（2.5毫克·千克-1·分钟-1）或0.9%生理盐水，持续2小时，之后再次进行上述测量。
低剂量多培沙明对任何一项全身测量指标均无影响。胃黏膜内pH值中位数从7.23升至7.35（p<０.005），ICG血浆消失率中位数从7.6%升至11.3%·分钟-1（p<0.02），MEGX浓度中位数从4纳克·毫升-1升至10.2纳克·毫升-1（p<0.005）。多巴胺对任何测量变量均无影响。对照组各项指标无变化。
通过胃黏膜内pH值、利多卡因生成MEGX以及ICG清除率测量发现，低剂量多培沙明可增加内脏血流。全身测量指标未出现任何变化，提示这些效应是内脏血管选择性舒张的结果。在本研究使用的剂量下，多巴胺对内脏血流无影响。多培沙明可能对危重症患者内脏缺血的治疗有用。
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