Mitchell I M, Pollock J C, Jamieson M P
Department of Cardiac Surgery, Royal Hospital for Sick Children, Glasgow, Scotland.
Ann Thorac Surg. 1995 Dec;60(6):1741-4. doi: 10.1016/0003-4975(95)00809-8.
A reduction in liver function is common after cardiac operations, particularly in children with preexisting cardiac failure. The etiology is multifactorial, but the redistribution of organ blood flow that occurs during cardiopulmonary bypass implicates ischemia as one of the principal causes of injury. Dopamine hydrochloride is known to have specific effects on the renal circulation, and the aim of this study was to investigate its effects on hepatic perfusion.
Eight children with congenital heart disease were studied 6 hours after the end of cardiopulmonary bypass when they were fully rewarmed and hemodynamically stable. Using noninvasive auricular densitometry, we determined the percent disappearance rate of indocyanine green as an index of liver blood flow both before and 1 hour after commencing an infusion of dopamine at 4 micrograms.kg-1.min-1.
Results showed an increase of approximately 31% in the percent disappearance rate of indocyanine green with the addition of low-dose dopamine (4 micrograms.kg-1.min-1) (p < 0.01).
Dopamine may have a therapeutic role in increasing hepatic perfusion and minimizing any loss in liver function.
心脏手术后肝功能下降很常见，尤其是在已有心力衰竭的儿童中。病因是多因素的，但体外循环期间发生的器官血流重新分布表明缺血是损伤的主要原因之一。已知盐酸多巴胺对肾循环有特定作用，本研究的目的是探讨其对肝灌注的影响。
对8名先天性心脏病患儿在体外循环结束6小时后进行研究，此时他们已完全复温且血流动力学稳定。使用无创耳密度测定法，我们在开始以4微克·千克⁻¹·分钟⁻¹输注多巴胺之前和之后1小时，测定吲哚菁绿的消失率百分比作为肝血流指标。
结果显示，添加低剂量多巴胺（4微克·千克⁻¹·分钟⁻¹）后，吲哚菁绿消失率百分比增加了约31%（p < 0.01）。
多巴胺在增加肝灌注和尽量减少肝功能损失方面可能具有治疗作用。
