不同起始剂量多巴胺治疗早产儿低血压的疗效

Effect of different starting dose of Dopamine on hypotension in premature infants

目的探讨不同起始剂量多巴胺对提高低血压早产儿血压的效果及对后期脑功能的影响。方法诊断明确的56例低血压早产儿，先予10mL／kg的9g／L盐水扩容1次，然后随机分为A组（小起始剂量多巴胺＋多巴酚丁胺）和B组（大起始剂量多巴胺＋多巴酚丁胺），每组28例。2组多巴酚丁胺剂量均为2．5μg／（kg·min）。A组多巴胺起始剂量为2．5μg（kg·min），B组多巴胺起始剂量为5．0μg/（kg·min），药物剂量每20min加量1次，每次剂量分别增加2．5μg／（kg·min），直至平均动脉压（MBP）维持为≥胎龄周数的115％，最大剂量为15μg/（kg·min）。用药前及用药96h后，2组儿童均监测MBP、心率、末梢血糖，尿量、液体量、能量支持及是否需胰岛素治疗；给药前均行头颅B超检查，每1—2周复查，分析第1次和最后1次头颅超声结果。记录呼吸机支持持续时间、达全肠内营养日龄、支气管肺发育不良、PDA、NEC及肠穿孔发生情况。结果B组多巴胺累积剂量和最大滴速均显著高于A组[（10．42±3．27）mg／kg比（8．24±3．99）mg／kg，P〈0．05；（5．71±2．14）μg／（kg·min）比（3．71±1．78）μg／（kg·min），P〈0．01]。与A组比较，B组达全肠内营养日龄明显延长（26．71d比20．50d，P〈0．01），脑室周围高回声发生率高（53．6％比21．4％，P〈0．01）。2组需机械通气及持续时间、支气管肺发育不良、PDA、需胰岛素治疗、NEC及肠穿孔发生率比较差异均无统计学意义（P均〉0．05）。2组在用药6h后血压均能保持在稳定水平，差异无统计学意义（P〉0．05）。结论大起始剂量多巴胺能有效、稳步提高早产儿血压，但有肠道和脑部缺氧损伤的潜在可能，需要大样本进一步研究。

Objective To explore the effects of different starting doses of Dopamine for hypotension and the influences of brain in the prematurity. Methods Fifty-six preterm infants with hypotension were enrolled in the study after one dose of isotonic solution, and they were divided into 2 groups as group A and group B. The patients in the 2 groups both received Dobutamine at 2.5 μg/（ kg . min）. Group A also received Dopamine of starting dose at 2.5 μg/ （kg .min） ,group B received Dopamine of starting dose at 5.0 μg/（ kg .min） , and the dose increased by 2.5 μg/ （kg .min） in a stepwise fashion every 20 minutes until the mean blood pressure（MBP） ≥ 115% of the weeks of the gestational age or a maximal dose of 15 μg/（ kg . min）. The MBP, heart rate, peripheral blood glucose, urine output, fluid intake, carbohydrate debit and the need for insulin therapy during the 96 h of the treatment were monitored. Before medicine administration, a complete cerebral ultrasound scan was made, and repeated every 1 -2 weeks, the initial and final cerebral ultrasound diagnosis were analyzed. Duration of respiratory support, incidence of bronchopulmonary dys- plasia（ BPD ）, patent ductus arteriosus （PDA）, the time of full enteral nutrition were recorded, nieerotizing enteroeolitis （NEC） and bowel perforation. Results Compared with group A, the mean drug dose and maximum infusion required to normalize blood pressure were significantly higher in group B [ （ 10.42 ±3.27 ） mg/kg vs （ 8.24 ±： 3.99 ） mg/kg, P 〈 0. 05 ; （5.71 ± 2.14 ）μg/（ kg.min） vs （3.71 ± 1.78 ） μg/（ kg . min ）, P 〈 0.01 ]. The postnatal age at which full enteral nutrition reached was significantly delayed in group B （26.71 d vs 20.50 d, P 〈 0.01 ）. The rate of periventricu- lar echogenicity was significantly higher in group B （53.6% vs 21.4% , P 〈 0.01 ）. The differences of need for mecha- nical ventilation and duration, the incidence of BPD, PDA, need insulin therapy, NEC and bowel perforation between the 2 groups were not statistically significant（ all P 〉 0.05 ）. The blood pressure 6 hours after the Dopamine can maintain at stable level, and the difference was not statistically significant （ P 〉 0.05 ）. Conclusions The larger starting dose of Dopamine can raise the blood pressure effectively, but it has potential intestinal and brain hypoxia injury. More trials are needed with larger sample size for further study.