多巴胺对体外循环下冠状动脉旁路移植术患者肝脏血流量的影响

The influence of dopamine on the hepatic blood flow in patients undergoing coronary artery bypass grafting by cardiopulmonary bypass

目的:观察体外循环期间持续输注多巴胺对患者肝静脉血流动力学的影响。方法:选择20例择期行冠状动脉旁路移植术(CABG)患者,随机分成多巴胺组和对照组,多巴胺组在体外循环开始时泵注2μg/(kg·min)多巴胺,分别于全麻诱导后(T0)、体外循环开始后5 min(T1)、体外循环后30 min(T2)及体外循环停机后30 min(T3),记录血流动力学变化(心率、血压等)及肝静脉血流相关指标(肝静脉直径、流速等)。比较术前与术后第1天肝肾功能的变化。结果:两组体外循环后血压均下降,多巴胺组停机后心率较对照组增快(P<0.05);多巴胺组体外循环期间肝静脉血流量较术前有所上升(P<0.05),但与对照组比较差异无统计学意义。与对照组相比,多巴胺组肌酐及尿素氮下降。结论:持续泵注2μg/(kg·min)小剂量泵注多巴胺可能增加肝静脉血流,但仍需进一步研究合适的多巴胺剂量使其达到更好的临床效果。

Objective：To observe influence of dopamine on hepatic vein hemodynamics during cardiopulmonary bypass. Methods： Tweenty patients undergoing CABG were randomly divided into dopamine group and control group. The hemodynamics changes（HR, MAP,CVP,CI,et al） and the related hepatic vein flow indicators（hepatic vein diameter,hepatic vein flow,et al） were measured by Transesophageal echocardiography. These data were recorded after general induction,5 minutes after cardiopulmonary bypass beginning,30 minutes after cardiopulmonary bypass beginning,and 30 minutes after off-pump,and the liver and kidney changes were compared between preoperation and postoperation. Results：Blood pressure decreased in the two groups after cardiopulmonary bypass, heart rate of dopamine group was higher than that of the control group after offpump（P 0.05）. The liver blood flow of dopamine group during cardiopulmonary bypass increased compared with preoperation（P 0.05）,but these was no significant difference compared with control group. Creatinine and blood urea nitrogen of dopamine group was lower after surgery compared with control group（P 0.05）. Conclusion：Continous infusion of dopamine with 2 μg / kg·min could increase hepatic blood flow,but it needs further reaearches of appropriate dose of dopamine to getting a better clinical effect.