Lherm T, Troché G, Rossignol M, Bordes P, Zazzo J F
Departement d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
Intensive Care Med. 1996 Mar;22(3):213-9. doi: 10.1007/BF01712239.
To evaluate the renal effects of low-dose dopamine in patients with sepsis syndrome or septic shock treated with catecholamines.
Prospective, clinical study using sequential periods.
A 12-bed surgical intensive care unit in a university hospital.
14 patients with sepsis syndrome and 15 patients with septic shock treated with exogenous catecholamines were studied. They had no diuretic treatment.
Two periods of 2 h each with and without 2 micrograms.kg-1.min-1 of dopamine infusion. Hemodynamic and renal data were obtained at the end of each period. Measurements were repeated after 48 h of dopamine infusion in patients with sepsis syndrome. All data were evaluated by the Wilcoxon rank test.
In patients with sepsis syndrome, diuresis and creatinine clearance increased significantly by 100% and 60%, respectively, during low-dose dopamine infusion without any change in systemic hemodynamics. The renal response to dopamine decreased significantly after 48 h of dopamine infusion (P < 0.01). In patients with septic shock treated with catecholamines, no variation of either systemic hemodynamics or renal function was noted during low-dose dopamine infusion.
The renal effects of low-dose dopamine in patients with sepsis syndrome decrease with time. No renal effect of low-dose dopamine was observed in patients with septic shock treated with catecholamines. These findings suggest a desensitization of renal dopaminergic receptors.
评估小剂量多巴胺对接受儿茶酚胺治疗的脓毒症综合征或感染性休克患者肾脏的影响。
采用序贯阶段的前瞻性临床研究。
一所大学医院的拥有12张床位的外科重症监护病房。
对14例脓毒症综合征患者和15例接受外源性儿茶酚胺治疗的感染性休克患者进行研究。他们未接受利尿治疗。
分别进行两个2小时的阶段，一个阶段输注2微克·千克⁻¹·分钟⁻¹的多巴胺，另一个阶段不输注。在每个阶段结束时获取血流动力学和肾脏数据。脓毒症综合征患者在输注多巴胺48小时后重复测量。所有数据采用Wilcoxon秩和检验进行评估。
在脓毒症综合征患者中，小剂量多巴胺输注期间尿量和肌酐清除率分别显著增加了100%和60%，而全身血流动力学无任何变化。多巴胺输注48小时后，肾脏对多巴胺的反应显著降低（P < 0.01）。在接受儿茶酚胺治疗的感染性休克患者中，小剂量多巴胺输注期间全身血流动力学和肾功能均未出现变化。
小剂量多巴胺对脓毒症综合征患者的肾脏影响随时间而降低。在接受儿茶酚胺治疗的感染性休克患者中未观察到小剂量多巴胺对肾脏的影响。这些发现提示肾脏多巴胺能受体脱敏。
