Dobutamine预处理对离体大鼠缺血/再灌注心肌的保护作用

为观察ｄｏｂｕｔａｍｉｎｅ（ＤＢ）预处理是否对缺血／再灌注心肌具有保护作用，２０只大白鼠随机分为两组：Ⅰ组全心缺血３０ｍｉｎ再灌注３０ｍｉｎ；Ⅱ组在３０ｍｉｎ缺血前用１０－６Ｍ·ＬＤＢ灌注５ｍｉｎ，随后用正常Ｋ－Ｈ液冲洗１０ｍｉｎ。结果显示：ＤＢ预处理组再灌注期间心率及冠脉回流量增加；再灌性心律失常发生率显著降低；心肌匀浆ＭＤＡ降低ＳＯＤ活性升高；心肌质膜Ｎａ＋－Ｋ＋ＡＴＰａｓｅ活性增高。表明：短时间ＤＢ预处理可以防止缺血／再灌注对心肌的损害。

Inhibitory effects of dobutamine on human gastric adenocarcinoma

AIM: To explore the inhibitory effects of dobutamine on gastric adenocarcinoma cells.

The effects of anisodamine and dobutamine on gut mucosal blood flow during gut ischemia/reperfusion

AIM: To determine if anisodamine is able to augment mucosal perfusion during gut I/R ischemia-reperfusion. METHODS: A jejunal sac was formed in Sprague Dawley rat. A Laser Doppler probe and a tonometer were inserted into the sac which was filled with saline. The superior mesenteric artery was occluded (SMAO)for 60 minutes followed by 90 minutes of reperfusion. At the end of 60 minutes of SMAO, either 0.2 mg/kg of anisodmine or dobutamine was injected into the jejunal sac. Laser Doppler mucosal blood flow and regional PCO2 (PrCO2)measurements were made. RESULTS: Mucosal blood flow was significantly increased at 30,60 and 90 minutes of reperfusion (R30, R60, R90) when intraluminal anisodamine or dobutamine was present compared to intraluminal saline only(44+/-3.3% or 48+/-4.1% vs 37+/-2.6% at R30, 57+/-5.0% or 56+/-4.7% vs 45+/-2.7% at R60, 64+/-3.3% or 56+/-4.2% vs 48+/-3.4% at R90,respectively P【0.05). Blood flow changes were also reflected by lowering of jejunal PrCO2 measurements after intraluminal anisodamine or dobutamine compared with that of the saline controls (41+/-3.1 mmHg or 44+/-3.0 mmHg vs 49+/-3.7 mmHg at R30,38+/-3.7 mmHg or 40+/-2.1 mmHg vs 47+/-3.8 mmHg at R60,34+/-2.1 mmHg or 39+/-3.0 mmHg vs 46+/-3.4 mmHg at R90, respectively, P【0.05). Most interesting finding was that there were significantly higher mucosal blood flow and lower jejunal PrCO2 in anisodamine group than those in dobutamine group at 90 minutes of reperfusion(64+/-3.3% vs 56+/-4.2% for blood flow or 34+/-2.1 mmHg vs 39+/-3.0 mmHg for PrCO2, respectively, P【0.05), suggesting that anisodamine had a more lasting effect on mucosal perfusion than dobutamine. CONCLUSION: Intraluminal anisodamine and dobutamine can augment mucosal blood flow during gut I/R and alleviate mucosal acidosis. The results provided beneficial effects on the treatment of splanchnic hypoperfusion following traumatic or burn shock.

Optimization and validation of a fast RP-HPLC method for the determination of dobutamine in rat plasma:Pharmacokinetic studies in healthy rat subjects

A novel isocratic reverse phase high performance liquid chromatography （RP-HPLC） with photo diode array （PDA） detection method for the determination of dobutamine （DBT） in rat plasma was developed and validated after optimization of various chromatographic conditions and other experimental parameters. Homoveratrylamiue was used as an internal standard. Methanol was used as the extracting solvent for the preparation of plasma samples. Samples were separated on a Symmetry C18 （250ram x4.6mm i.d., 5 pro） analytical column. Acetonitrile and 15raM potassium dihydrogen phosphate （pH 5.0 with 0.3% TEA） （20：80, v/v） was used. The column oven temperature was optimized at 35 ~C and the flow rate was 0.8 mL/min. The detection wavelength was fixed at 230 nm for entire analysis. The calibration curve was found to be linear over the concentration range of 50-2000 ng/mL （ra=0.9992）. The limit of quantification （LOQ） of the method was 50 ng/mL. The % RSD values of accuracy and precision values for intra and inter days were 〈 15% at quality control （QC） concentrations. Recovery, stability and robustness were studied within the acceptable range according to ICH guidelines. The method was efficiently applied to a pharmacokinetic study in healthy Wistar rats.

Value of Low Dose Dobutamine Doppler Tissue Imaging for Detecting Hibernating Myocardium

Summary: In order to assess the value of Doppler tissue imaging (DTI) in detecting viable hibernating myocardium, 20 patients with coronary artery disease and chronic left ventricular dysfunction underwent low dose dobutamine stress echocardiography and low dose dobutamine stress DTI. The results showed that among the 100 asynergic segments, 35 segments showed improvement after dobutamine infusion (group H) and no changes were observed in the remaining 65 segments (group N). The left ventricular echocardiographic score index decreased from 1.60±0. 35 to 1.44±0.36 ( n =20, P <0.01). During low dose dobutamine stress DTI, there was no difference in the values of velosity of S wave (V s) before dobutamine infusion between two groups. However, after dobutamine infusion, the values of V s and VR in group H were significantly higher than those in group N (V s:10.1±3.0 cm/s vs 7.3±2.2 cm/s, P <0.01; VR: 60 %±41 % vs 25 %±32 %, P <0.001). 95.7 % asynergic myocardial segments with VR≤0 had no viability while 86 % asynergic segments with VR>80 % were viable myocardium. It is concluded that the different reactions to dobutamine stress between hibernating and necrosis myocardium could be showed by DTI and it is more clinically significant when VR≤0 and VR>80 %.

Dobutamine Infusion and Absence of Pulmonary Hypertension Are Associated with Decreased Mortality in a Cohort of 249 Patients with Cardiogenic Shock

Objective: Prognostic analysis of 249 patients admitted for cardiogenic shock (CS) of various origins. Background: Little is known about prognosis of CS from non-ischemic cardiomyopathy. Methods: Retrospective monocentric study of patients referred to an ICU during 2 years. Results: Despite aggressive management including intra-aortic balloon pump (31%), extra-renal replacement therapy (36%), extra-corporeal life support (8%), and catecholamine infusion (97%), in-hospital mortality was 46%. Toxic CS or CS related to deficiency carried a better outcome (mortality 5%). Post-myocardial infarction or post-cardiac arrest CS was associated with higher mortality. In the multivariate analyses, only SAPS II (OR 1.037;1.013 - 1.056;p = 0.0001), pulmonary hypertension (OR 4.8;1.3 - 17;p = 0.02), extra-renal replacement therapy (OR 2.9;1.3 - 6;p = 0.006), and dobutamine infusion (OR 0.44;0.2 - 0.96;p = 0.04) were significantly associated with in-hospital mortality. Conclusion: Dobutamine infusion was associated with a better outcome. Higher SAPS II, pulmonary hypertension, and extra-renal replacement therapy were associated with increased in-hospital mortality.

Diagnostic value of dobutamine stress Doppler tissue imaging in diabetic patients with suspected coronary artery disease

Background: Coronary artery disease (CAD) is often silent in diabetic patients, and it is typically in ad-vanced stages of development by the time it manifests. Various forms of stress testing have been investigated to detect obstructive CAD in diabetes mellitus. Ob-jectives: To assess the diagnostic value of dobutamine stress pulsed-wave Doppler tissue imaging (DTI) compared with standard wall motion analysis in de-tection of myocardial ischemia in diabetic patients with suspected CAD. Methods: The study comprised 46 diabetic patients with suspected CAD underwent dobutamine stress echocardiography (DSE) with DTI within 4 weeks before coronary angiography(CA). Dobutamine infusion started at 5 μ/kg/min and in-creased up to 40 μ/kg/min with additional atropine during submaximal heart rate responses. In addition to wall-motion score index (WMSI) analysis, pulsed- wave DTI examination of basal and mid segments of posteroseptal, lateral, anterior, inferior and antero- septal walls was performed. Myocardial velocities were measured at rest in the apical 4, 3 and 2-cham- ber views. The measurements were repeated at low dose (10 - 15 μ/kg/min) and at peak stress (40 μ/kg/min). DTI measurements included peak systolic velocity (S), peak early diastolic velocity (E) and peak late diastolic velocity (A) and the results were com-pared to WMSI analysis. Patients were classified into two groups according to CA results;group (I) di-abetics with positive CA (n = 27) and group (II) di-abetics with negative CA (n = 19). Results: There was no significant difference between the two groups in duration of diabetes, global WMSI at rest or the ? changes (stress-rest/rest) of WMSI (P > 0.05). Global S and global E were significantly lower in group I compared to group II at peak stress (11.3 ± 3.7 cm/sec vs. 14.5 ± 2.2 cm/sec, p < 0.01) and (11.3 ± 1.6 cm/sec vs. 13.1 ± 2.1 cm/sec, p < 0.01) respectively. The cutoff points for global S and global E to detect obstructive CAD in diabetics were 11.3 cm/s and 11.2 cm/s re-spectively with 75.7%, 73.4% sensitivity and 94.7%, 89.47% specificity respectively. An increment (? changes) less than 0.56 in S or 0.26 in E from rest to peak stress identified CAD with 78.8 %, 89.3% sensi-tivity and 94.7%, 90.7% specificity respectively. The accuracy of DTI parameters during peak stress was higher than WMSI analysis (sensitivity 74.1% vs. 59.3% and specificity 90% vs. 79%, P < 0.01 for each). In multivariate regression analysis, only ?S and ?E were independent predictors of obstructive CAD in diabetics (odd ratio: 36.16, 95% CI, 1.34- 532.01 and 63.77, 95% CI, 3.19-721.47) respectively. Conclusion: Quantitative analysis, using DTI during DSE, adds new dimension in diagnosis of myocardial ischemia. It is more sensitive, specific, accurate and reproducible compared with standard wall motion analysis for recognition of significant CAD in diabetic patients.

The Value of Speckle Tracking Strain Imaging at Recovery Period of Dobutamine Stress Echocardiography

Background: Dobutamine stress echocardiography (DSE) is a well-established method for detecting myocardial ischemia. The classic echocardiographic findings of ischemia are new or worsening abnormalities of radial wall thickening. However, interpretation of these findings is subjective and dependent on experience. Speckle tracking strain imaging (STI) has been introduced as a novel method to overcome these limitations. Objective: The aim of the study is to evaluate the value of speckle tracking imaging (STI) by estimating the mean global longitudinal systolic (GLS) and the mean global circumferential systolic (GCS) strain imaging at recovery period of dobutamine stress echocardiography for prediction of significant coronary artery disease (CAD) in patients with chest discomfort. Methods: Fifty three patients presented for evaluation of chest discomfort underwent dobutamine stress echocardiography and coronary angiography at Cardiology Department,Menoufia University Hospital. The mean global left ventricular longitudinal systolic strain (GLS) at apical views—3 chambers, 4 chambers & 2 chambers apical views and global left ventricular circumferential systolic strain (GCS) at short axis view at level of papillary muscle were measured at rest and during recovery period of dobutamine stress echocardiography using automated functional imaging (AFI). Coronary angiography was done for all patients. Significant coronary artery lesion was defined as having a ≥ 70% diameter stenosis on coronary angiography. Patients were divided into two groups based on the presence or absence of significant coronary artery lesion into CAD positive (+ve) group vs. CAD negative (-ve) group. Results: In both groups,there were no statistically significant differences in the clinical characteristics and baseline conventional transthoracic echocardiography. GLS and GSC at recovery were lower in the CAD (+ve) group than in the CAD (-ve) group (-16.69% ± 1.10% vs -19.05% ± 1.41% p ). GLS and GCS during recovery period of DSE were valuable for prediction of CAD when cutoff at recovery is less than -17.95% (sensitivity of 84% & specificity of 84%) for GLS and less than -20.2% (sensitivity of 76% & specificity of 84%) for GCS. Also, we observed that the GLS and GCS percentile decreased from baseline to recovery period of DSE by about -9.95% ± 4.82% and -7.72% ± 3.90% respectively. Conclusion: Speckle tracking Imaging GLS and GCS at recovery period of Dobutamine Stress Echocardiography is feasible and offers an objective technique for prediction of significant coronary artery disease with increasing the accuracy of DSE in patient with chest discomfort.

Effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia

Objective:To study the effect of dobutamine combined with meropenem on serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP in children with congenital heart disease and pneumonia.Methods:A total of 70 children with congenital heart disease and pneumonia in our hospital from June 2014 to Octomber 2016 were enrolled in this study. The subjects were divided into the control group (n=35) and the treatment group (n=35) randomly. The control group was treated with dobutamine, the treatment group were treated with dobutamine combined with meropenem. The two groups were treated for 10 days. The serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before and after treatment were compared.Results: There were no significantly differences of the serum BNP, IGF-1, IGFBP-3, TNF-a, IL-6 and hs-CRP levels of the two groups before treatment. The serum BNP, TNF-a, IL-6 and hs-CRP levels of the two groups after treatment were significantly lower than before treatment, the serum IGF-1 and IGFBP-3 levels of the two groups after treatment were significantly higher than before treatment, and that of the treatment group were significantly better than the control group.Conclusion:Dobutamine combined with meropenem can significantly reduce the serum BNP, TNF-a, IL-6 and hs-CRP levels, improve serum IGF-1 and IGFBP-3 levels of children with congenital heart disease and pneumonia, and it was worthy clinical application.

Prognostic Utility of Dobutamine Stress Echocardiography in the Obese African American Population

Background: The predictive value of Dobutamine Stress Echocardiography (DSE) in the obese African American patient population is not well known. Methods: We conducted a retrospective study of 555 African American patients between 1/1/2001-12/31/2001. DSE responses were classified into normal, ischemia, scar, or scar +/? ischemia. End-points utilized were all cause death (ACD) and major adverse cardiac events (MACE). Results: There were a total of 409 obese patients and 146 non-obese patients. By multi-variate analysis only the scar group in the obese population predicted ACD (p = 0.003) and combined MACE (p = 0.014). Kaplan Meir analysis demonstrated that only the scar group was associated with decrease in freedom from all cause death (p < 0.001) and combined MACE (p < 0.001). Conclusion: DSE retains its prognostic power in the obese African American population and scar has important impli-cations for MACE.

借助计算机测算DBTM-St-MMA三元共聚体系的竞聚率

采用红外光谱法测定了不同转化率下 DBTM-St-MMA三元共聚体系共聚物的组成 .根据改进的欧拉公式 ,解得 Alfrey-Goldfinger微分方程的数值积分 ,将单纯形调优法与数值积分法相结合 ,建立数学模型并编写微机程序 .应用所编制的程序 ,根据三元共聚体系的起始组成和不同转化率下共聚物的组成 ,计算该三元共聚体系单体的竞聚率 .

不同机械通气方案联合多巴酚丁胺治疗新生儿持续肺动脉高压的临床效果对比

目的对比新生儿持续性肺动脉高压(PPHN)患儿应用不同机械通气方案联合多巴酚丁胺治疗的临床效果。方法选取2019年1月至2022年12月郑州大学第一附属医院收治的82例PPHN患儿,利用计算机生成的随机数字分成两组,每组41例。两组均接受常规治疗,对照组接受常频机械通气联合多巴酚丁胺治疗,观察组接受高频振荡通气联合多巴酚丁胺治疗,两组均治疗2 d。对比两组临床疗效、血气分析指标以及相关血清指标[氨基末端脑钠肽前体(NT-proBNP)与肌酸激酶同工酶(CK-MB)]。结果观察组总有效率高于对照组(P<0.05)。两组患儿治疗2 d后动脉血氧分压(PaO_(2))、动脉血氧饱和度(SaO_(2))升高,动脉血二氧化碳分压(PaCO_(2))下降,且观察组PaO_(2)、SaO_(2)高于对照组,PaCO_(2)低于对照组(P<0.05)。两组患儿治疗2 d后NT-proBNP、CK-MB水平降低,且观察组NT-proBNP、CK-MB水平低于对照组(P<0.05)。结论将高频振荡通气与多巴酚丁胺联合应用于PPHN患儿治疗中效果显著,可改善血气分析指标,减轻心肌损伤。

经鼻持续气道正压通气联合多巴胺与多巴酚丁胺治疗婴幼儿重症肺炎的临床价值

目的探讨经鼻持续气道正压通气联合多巴胺、多巴酚丁胺治疗婴幼儿重症肺炎的临床价值。方法选取2020年1月至2022年7月抚州市第一人民医院收治的80例婴幼儿重症肺炎患儿作为研究对象,随机分为对照组与观察组,各40例。对照组采用经鼻持续气道正压通气疗法,观察组在对照组基础上联合多巴胺、多巴酚丁胺治疗,比较两组呼吸机应用时间、治疗5 d后心力衰竭发生率、临床疗效、症状体征恢复时间、心率、呼吸频率及肺功能指标。结果观察组呼吸机应用时间短于对照组,治疗5 d后心力衰竭发生率低于对照组,差异有统计学意义(P<0.05)。观察组临床病情控制优良率为95.00%,高于对照组的77.50%,差异有统计学意义(P<0.05)。观察组肺部湿啰音消失时间、三凹征消失时间、心率恢复正常时间、呼吸频率恢复正常时间均短于对照组,差异有统计学意义(P<0.05)。治疗5 d后,观察组心率、呼吸频率均慢于对照组,差异有统计学意义(P<0.05)。治疗5 d后,观察组FEV1、FVC、FEV1/FVC均大于对照组,差异有统计学意义(P<0.05)。结论将经鼻持续气道正压通气联合多巴胺与多巴酚丁胺疗法治疗婴幼儿重症肺炎效果显著,能缩短呼吸机应用时间及症状体征恢复时间,降低心力衰竭发生率,促进心率及呼吸频率恢复正常,改善患儿肺功能。

左西孟旦联合多巴酚丁胺治疗急性失代偿心力衰竭患者的效果

目的:观察左西孟旦联合多巴酚丁胺治疗急性失代偿性心力衰竭(ADHF)患者的效果。方法:选取2020年3月至2022年10月该院收治的80例ADHF患者进行前瞻性研究,按照随机数字表法将其分为对照组和观察组各40例。两组均进行对症治疗,在此基础上,对照组予以多巴酚丁胺治疗,观察组在对照组基础上联合左西孟旦治疗,两组均连续治疗5 d。比较两组临床疗效,治疗前后心功能指标[左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)]水平、血清学指标[脑钠肽(BNP)、N末端脑钠肽前体(NT-proBNP)]水平,以及不良反应发生率。结果:观察组治疗总有效率为97.50%(39/40),高于对照组的77.50%(31/40),差异有统计学意义(P<0.05);治疗后,观察组LVEF水平高于对照组,LVEDV、LVESV水平均低于对照组,差异有统计学意义(P<0.05);治疗后,观察组BNP、NT-proBNP水平均低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:左西孟旦联合多巴酚丁胺治疗ADHF患者可提高治疗总有效率,改善心功能指标水平,降低血清学指标水平,效果优于单纯多巴酚丁胺治疗。

多巴酚丁胺联合硝酸甘油在实施控制性低中心静脉压技术中的应用效果探讨

目的探究多巴酚丁胺联合硝酸甘油在实施控制性低中心静脉压(CLCVP)技术中的应用效果及其对患者血流动力学的影响。方法50例肝部分切除(切除≥2个肝叶)患者,随机分为N组(24例)和D组(26例)。在手术开始至切肝及止血完成阶段,N组使用硝酸甘油维持中心静脉压(CVP)<5 cm H_(2)O(1 cm H_(2)O=0.098 kPa),D组使用多巴酚丁胺联合硝酸甘油维持CVP<5 cm H_(2)O。比较两组手术情况[手术时间、肝切除后(T4)和术毕(T5)输液量、尿量、术中出血量],CVP、心脏指数(CI),术野等级,血红蛋白(Hb)、红细胞比容(HCT)水平,肝、肾功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)、尿素氮(BUN)]。结果D组手术时间(222.8±81.6)min较N组的(277.1±61.3)min短,T5输液量(2946.1±398.6)ml及术中出血量(223.0±115.5)ml较N组的(3233.5±444.3)、(404.8±219.6)ml少(P<0.05);两组T4输液量及尿量比较无差异(P>0.05)。与N组比较,D组在手术开始后15 min(T2)时的CVP明显低于N组(P<0.05);诱导后(T1)、肝切除开始(T3)、T4时D组CVP与N组比较无统计学意义(P>0.05);两组CVP在T2、T3、T4时均较T1低(P<0.05),在T5时恢复至接近T1水平(P>0.05)。D组在T3时的CI明显高于N组(P<0.05);D组在T1、T2、T4、T5时的CI与N组比较无统计学差异(P>0.05);N组在T1~T4时CI组内比较无统计学意义(P>0.05),在T5时CI较T1时高(P<0.05);D组在T2、T3、T5时CI较T1时高(P<0.05),T4时CI与T1比较无统计学差异(P>0.05)。D组术中术野等级优于N组,有统计学差异(P<0.05)。D组在T4、T5的Hb、HCT均较N组高(P<0.05);两组T1时的Hb、HCT无统计学差异(P>0.05);两组患者Hb、HCT在T4和T5时均较T1降低(P<0.05)。两组术前及术后第1、3、7天ALT、AST、BUN、Cr比较,差异均无统计学意义(P>0.05);两组术后第1、3、7天BUN和Cr与术前比较,无统计学差异(P>0.05);两组ALT、AST在术后第1、3天均较术前增高(P<0.05),术后第7天与术前比较无统计学差异(P>0.05)。结论在实施CLCVP技术中应用多巴酚丁胺联合硝酸甘油可更有效降低CVP,维持循环稳定,并减少术中出血量。

多巴酚丁胺可增强奎扎替尼对FLT3-ITD突变型急性髓系白血病的靶向抑制作用

目的:观察多巴酚丁胺对人FLT3-ITD突变型急性髓系白血病(AML)细胞的增殖抑制作用,探讨多巴酚丁胺单药或者联合奎扎替尼治疗该型AML的可行性。方法:体外培养FLT3-ITD突变AML细胞系MOLM13及MV4-11,实验分为对照组、多巴酚丁胺处理组、奎扎替尼处理组、多巴酚丁胺联合奎扎替尼处理组,采用CCK-8法、流式细胞术分别检测各组细胞活性、细胞凋亡率及ROS水平,并通过Western blot检测YAP1蛋白的表达。结果:多巴酚丁胺和奎扎替尼均可抑制FLT3-ITD突变型AML细胞系MOLM13、MV4-11的增殖。与对照组相比,多巴酚丁胺组FLT3-ITD突变AML细胞的ROS水平显著上升(P<0.01),凋亡率增加(P<0.05),其YAP1蛋白的表达减少(P<0.05);与多巴酚丁胺组相比,奎扎替尼联合多巴酚丁胺组的细胞活性显著降低(P<0.05),ROS水平上升(P<0.01),YAP1表达减少(P<0.05)。结论:多巴酚丁胺单药可抑制FLT3-ITD突变型AML细胞的增殖,引起其凋亡,且联合奎扎替尼可增强对FLT3-ITD突变型急性髓性白血病的靶向抑制作用。其机制可能是通过抑制该型AML细胞YAP1蛋白的表达,提高ROS水平从而发挥其抗肿瘤作用。

质量源于设计在盐酸多巴酚丁胺注射液处方工艺研究中的应用

目的基于质量源于设计(quality by design,QbD)的理念,建立仿制药盐酸多巴酚丁胺注射液目标产品质量概况(quality target product profile,QTPP),确定目标产品的关键质量属性(critical quality attributes,CQA),制定药液pH值的控制策略,优化灌装工艺以控制自研品顶空残氧量。方法方案设计药液pH值为2.0、2.5、3.3、4.0和5.5,对制备的样品放置影响因素,考察不同药液pH值对制剂质量的影响。以灌装速度、灌装前后的氮气流速、加塞前以及加塞中的氮气流速为自变量,实测残氧量为因变量进行3个中心点的1/2部分因子试验,对灌装充氮工艺进行优化。结果pH值2.5~5.5范围内各样品性状和溶液的澄清度与颜色、总杂及各单杂均未变化,样品质量稳定。确定灌装线的充氮参数和灌装速度的最佳空间40%~67%。结论本实验研究确定了仿制药盐酸多巴酚丁胺注射液的pH值控制范围以及最佳灌装充氮工艺参数,合理可行,可较好控制产品质量。

左西孟旦联合多巴酚丁胺对急性心力衰竭患者炎症反应及心功能的影响

目的:探讨联合应用左西孟旦与多巴酚丁胺治疗急性心力衰竭(AHF)的效果。方法:选取2022年1月—2023年7月在莆田学院附属医院接受治疗的82例AHF患者作为研究对象,使用随机数表法将其分为常规组(n=41)与治疗组(n=41)。常规组给予多巴酚丁胺治疗,在常规组基础上治疗组加用左西孟旦治疗。比较两组临床疗效、心功能[每搏输出量(SV)、左心室射血分数(LVEF)、心脏指数(CI)]、炎症反应[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]及不良反应。结果:与常规组比较,治疗组总有效率更高,差异有统计学意义(P<0.05);与治疗前比较,两组治疗后SV、LVEF、CI升高,且治疗组上述指标较常规组更高,差异有统计学意义(P<0.05);与治疗前比较,两组治疗后血清hs-CRP、IL-6、TNF-α水平下降,且治疗组上述指标较常规组更低,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:左西孟旦联合多巴酚丁胺治疗AHF效果确切,可降低炎症反应,减轻心肌损伤,改善心功能,且安全性较好。

左西孟旦治疗感染性休克合并心肌抑制的临床观察

目的探讨左西孟旦对感染性休克合并心肌抑制患者心脏功能、血流动力学和预后的影响,并评价其安全性。方法选择2021年4月-2023年8月入住重庆大学附属三峡医院重症医学科、经充分液体复苏、平均动脉压(MAP)≥65 mmHg且接受脉搏指示连续心输出量(PiCCO)监测的感染性休克合并心肌抑制患者,按随机数字表法分为多巴酚丁胺组和左西孟旦组,每组20例。两组患者均静脉泵入重酒石酸去甲肾上腺素注射液0.1~2.0μg/(kg·min)。在此基础上,多巴酚丁胺组患者加用盐酸多巴酚丁胺注射液5~10μg/(kg·min),连续静脉泵入3~7 d;左西孟旦组患者加用左西孟旦注射液0.1~0.2μg/(kg·min),连续静脉泵入24h。比较两组患者治疗前及治疗后24、72 h的心率(HR)和血流动力学指标[收缩压、舒张压、MAP、中心静脉压(CVP)]、PiCCO监测指标[心功能指数(CFI)、心指数(CI)、每搏量指数(SVI)、血管外肺水指数、全心舒张末期容积指数、肺血管通透性指数(PVPI)、全心射血分数(GEF)、系统血管阻力指数、左心室收缩力指数]和预后指标[用药后3 d内死亡情况、机械通气时间、住重症监护病房(ICU)时间、28 d病死率],记录两组患者的不良反应发生情况。结果与同组治疗前比较,多巴酚丁胺组患者治疗后24 h的CFI、CI、GEF和治疗后72 h的CI、GEF以及左西孟旦组患者治疗后24 h的SVI和治疗后72 h的SVI、GEF均显著升高,多巴酚丁胺组患者治疗后72 h的PVPI显著降低(P<0.05);与同期多巴酚丁胺组比较,左西孟旦组患者治疗后24 h的HR显著降低,CVP显著升高(P<0.05)。给药后3 d内,两组均无患者死亡;其机械通气时间、住ICU时间、28 d病死率和不良反应发生率比较差异均无统计学意义(P>0.05)。结论对于经充分液体复苏、MAP≥65 mmHg且接受PiCCO监测的感染性休克合并心肌抑制患者,左西孟旦在改善心脏功能和血流动力学方面的作用与多巴酚丁胺相当,且不会影响患者预后,也不会增加低血压等不良反应的发生风险。