This weekend we conclude our discussion of renal dose dopamine and renal ischemia.
What are the clinical data with renal dopamine?
本周我们总结关于肾脏剂量DA与肾缺血的讨论：
有关肾脏DA的临床研究结果有哪些？
参考答案：
尚没有一个大型前瞻性、随机、控制、双盲实验对肾脏DA进行研究，但是有很多小型药物研究在围手术期和ICU中进行。
1991年，Swygert等[1]对接受肝移植的48名患者实施了前瞻性、随机、双盲试验研究。结果表明，两组之间GFR、尿量（UOP）或渗透量均无明显改善，治疗组的HR增加。1993年，Myles等[2]对接受心脏旁路术的52名患者进行前瞻性、随机、双盲试验研究，结果两组间UOP、肌酸酐清除率（CrCl）或肾脏衰竭均无差异。1994年，Baldwin等[3]对接受主动脉手术的37名患者进行前瞻性、随机、双盲试验，UOP、CrCl组间无差异，但治疗组中4例手术中出现MI，其中3例有差异。
1993年Martin等[4]在ICU对32名败血症休克患者进行前瞻性、随机、双盲试验研究。他们发现16名使用DA的患者中有5名UOP增加，而使用去甲肾上腺素的16名中有15名UOP增加。他们对使用DA后UOP未增加的11名患者又改用去甲肾上腺素，其中10名UOP增加。
1994年Robinson等[5]对17名CHF（充血性心力衰竭）患者进行随机、控制、双盲试验，结果UOP、GFR或有效肾血浆流量均无差异。同年Duke等[6]对ICU的23名患者进行前瞻、随机、双盲试验比较DA和多巴酚丁胺的作用效果，他们发现DA增加UOP而不增加CrCl，而多巴酚丁胺增加CrCl而不增加UOP。1996年 Chertow等[7]对256名接受DA治疗或仅接受常规治疗的急性肾功能衰竭患者进行回顾性分析，发现两组间生存率和透析率均无差异。
What are the clinical data with renal dopamine?
There are no large prospective, randomized, controlled, double-blinded studies using renal dopamine, but there are numerous small studies with the drug in the perioperative and ICU setting.
In 1991, Swygert et al. (1) performed a prospective, randomized, double-blinded trial on 48 patients undergoing liver transplantation. They showed no benefit in glomerular filtration rate (GFR), urine output (UOP), or dialysis requirement between the two groups. They did show an increase in heart rate in the treatment group. In 1993, Myles et al. (2) performed a prospective, randomized, double-blinded trial on 52 patients undergoing cardiac bypass surgery. They saw no difference in UOP, creatinine clearance (CrCl), or incidence of renal failure between the two groups. In 1994, Baldwin et al (3) performed a prospective, randomized, double-blinded trial on 37 patients undergoing aortic surgery. There was no difference in UOP or in CrCl, but 3 of the 4 perioperative MI's occurred in the treatment group.
In the ICU setting, Martin et al (4) in 1993 performed a prospective, randomized double-blinded study using dopamine or norepinephrine in 32 patients with septic shock. They found that dopamine improved UOP in 5 of 16 patient, while norepinephrine improved UOP in 15 of 16 patients. Further, when the patients who failed dopamine crossed over to the norepinephrine arm, UOP improved in 10 of 11.
In 1994, Robinson et al (5) performed a randomized, controlled, double-blind study on 17 patients with CHF, and found no difference in UOP, GFR, or effective renal plasma flow. The same year, Duke et al performed a prospective, randomized, double-blinded trial with dopamine vs. dobutamine in 23 ICU patients. They found that dopamine increased UOP, but not CrCl, while dobutamine increased CrCl but not UOP. Finally, in 1996, Chertow et al (7) published a retrospective study of 256 patients with acute renal failure who received dopamine with convential therapy or conventional therapy alone. They saw no difference between the two groups with regard to survival or need for dialysis.
Question author: Andrew Friedrich, MD, Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School
References:
1. Swygert TH, Roberts LC, Valek TR, Brajtbord D, Brown MR, Gunning TC, Paulsen AW, Ramsay MA. Effect of intraoperative low-dose dopamine on renal function in liver transplant recipients. Anesthesiology 1991 Oct;75(4):571-6 .
2. Myles PS, Buckland MR, Schenk NJ et al. Effect of "renal dose" dopamine on renal function following cardiac surgery. Anaesth Intens Care 1993; 21:56-61.
3. Baldwin, L. et al. Effect of postoperative low-dose dopamine on renal function after elective major vascular surgery. Ann Int Med 1994; 120:744-7.
4. Martin C, Papazian L, Perrin G, Saux P, Gouin F. Norepinephrine or dopamine for the treatment of hyperdynamic septic shock? Chest 1993 Jun;103:1826-31.
5. Robinson T, Gariballa S, Fancourt G, Potter J, Castleden M. The acute effects of a single dopamine infusion in elderly patients with congestive cardiac failure. Br J Clin Pharmacol 1994 Mar;37(3):261-3.
6. Duke GJ, Briedis JH, Weaver RA. Renal support in critically ill patients: low-dose dopamine or low-dose dobutamine? Crit Care Med 1994 Dec;22(12):1919-25.
7. Chertow, G. et al. Is the administration of dopamine associated with adverse or favorable outcomes in acute renal failure? Am J Med 1996; 101: 49-53.
8. Perdue, P. et al. "Renal dose" dopamine in surgical patients: dogma or science? Ann Surg 1998; 227(4): 470-3.
Site Editor: George Frendl, M.D., Ph.D.
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School
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