Van den Berghe G, de Zegher F, Lauwers P
Department of Intensive Care Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
Crit Care Med. 1994 Nov;22(11):1747-53.
Dopamine, a natural catecholamine with hypophysiotropic properties, is used as a first choice drug for inotropic and vasoactive support in pediatric intensive care. In infants and children, the pituitary gland plays a crucial role as a regulator of growth, metabolism, maturation and, possibly, immune function. We evaluated the effect of dopamine infusion (5 micrograms/kg/min i.v.) on the dynamics of prolactin, growth hormone, and thyrotropin secretion and on the thyroid axis in critically ill infants and children.
Prospective, randomized, controlled, open-labeled, clinical study.
Intensive care unit of a university hospital over a 9-month period.
The study population consisted of infants and children recovering from cardiovascular surgery. The group was stratified into two age groups (infants aged 12 to 90 days [n = 18] and children aged 0.3 to 6.7 yrs [n = 15]) and was studied dynamically (blood sampling every 20 mins for 3 hrs) on two consecutive days, after randomization for dopamine withdrawal on the first or the second day. Serum prolactin, growth hormone, insulin-like growth factor-1, thyrotropin, thyroxine (T4), triiodothyronine (T3), and reverse triiodothyronine (reverse T3) concentrations were measured.
In the newborns, dopamine was found to suppress prolactin, growth hormone, and thyrotropin secretion consistently, rebound releases starting within 20 mins after dopamine withdrawal. One day later, prolactin concentrations were ten times higher, pulsatile growth hormone secretion was augmented, thyrotropin was unchanged, but T3 was increased by 30% and the T3/reverse T3 ratio was inverted. In the children, dopamine suppressed prolactin and thyrotropin (but not growth hormone) secretion, rebound releases starting within 20 mins after dopamine withdrawal. One day later, prolactin concentrations were at least twice as high, thyrotropin was increased ten-fold, T4 was augmented by 14%, T3 by 30% and the T3/reverse T3 ratio had doubled. Neither in newborns nor in children did dopamine withdrawal appear to affect the low serum insulin-like growth factor-1 concentrations.
The data indicate that dopamine infusion induces or aggravates partial hypopituitarism and the euthyroid sick syndrome in critically ill infants and children.
多巴胺是一种具有促垂体作用的天然儿茶酚胺，在儿科重症监护中用作正性肌力和血管活性支持的首选药物。在婴儿和儿童中，垂体作为生长、代谢、成熟以及可能的免疫功能的调节者发挥着关键作用。我们评估了静脉输注多巴胺（5微克/千克/分钟）对危重症婴儿和儿童催乳素、生长激素和促甲状腺激素分泌动态以及甲状腺轴的影响。
前瞻性、随机、对照、开放标签的临床研究。
一所大学医院的重症监护病房，为期9个月。
研究人群包括心血管手术后康复的婴儿和儿童。该组被分为两个年龄组（12至90天的婴儿[n = 18]和0.3至6.7岁的儿童[n = 15]），在随机分配于第一天或第二天停用多巴胺后，连续两天进行动态研究（每20分钟采血一次，共3小时）。测量血清催乳素、生长激素、胰岛素样生长因子-1、促甲状腺激素、甲状腺素（T4）、三碘甲状腺原氨酸（T3）和反三碘甲状腺原氨酸（反T3）浓度。
在新生儿中，发现多巴胺持续抑制催乳素、生长激素和促甲状腺激素分泌，多巴胺停用后20分钟内开始出现反跳性释放。一天后，催乳素浓度高出十倍，生长激素的脉冲式分泌增加，促甲状腺激素未改变，但T3增加了30%，T3/反T3比值倒置。在儿童中，多巴胺抑制催乳素和促甲状腺激素（但不抑制生长激素）分泌，多巴胺停用后20分钟内开始出现反跳性释放。一天后，催乳素浓度至少高出两倍，促甲状腺激素增加了十倍，T4增加了14%，T3增加了30%，T3/反T3比值翻倍。无论是在新生儿还是儿童中，停用多巴胺似乎都未影响低血清胰岛素样生长因子-1浓度。
数据表明，静脉输注多巴胺会诱发或加重危重症婴儿和儿童的部分垂体功能减退和正常甲状腺病态综合征。
