课件：多巴胺应用于临床.pptVIP

最终的结果 因此，尽管LDD可以引起肾脏血流的增加，但这是以损失有代谢活性的外层髓质的血流为代价的，导致局部缺血的易感性增加，最终导致急性肾衰。 因此， LDD可增加健康志愿者的肾血流和肾小球滤过率，但在早期肾衰的患者确未发现同样的结果。即使有，也是因为LDD对心脏的作用导致肾脏的作用。实际上，在心排量下降或低血容量情况下，尚未证实存在药物诱导的利尿作用具有肾保护作用。 现在有确凿的研究结果证实LDD没有有意义的益处。较大剂量的DA对肾脏生理的影响来自于它对心脏的作用，而这种作用使用其他药物也可以达到。 肾保护功能已被驳倒那么升压功能如何？ Results The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P=0.03 for cardiogenic shock, P=0.19 for septic shock, and P=0.84 for hypovolemic shock, in Kaplan–Meier analyses). Conclusions Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. 既然如此，多巴胺是否就一无是处甚至不能用了？ 反思 1. 是否过于迷信教科书或权威？ 2. 是否经常更新知识？为什么某些知识会更新？ 3. 当一种药物存在缺陷时，我们该如何应用？ 谢谢 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 主要经营：网络软件设计、图文设计制作、发布广告等 公司秉着以优质的服务对待每一位客户，做到让客户满意！ 致力于数据挖掘，合同简历、论文写作、PPT设计、计划书、策划案、学习课件、各类模板等方方面面，打造全网一站式需求 * * * * 多巴胺迷茫，真相与反思 多巴胺的用法 你还记得吗？ 说明书的用法（2005年版中国药典） 小剂量时（每分钟按体重0.5－2ug/㎏），主要作用于多巴胺受体，使肾及肠系膜血管扩张，肾血流量及肾小球滤过率增加，尿量及钠排泄量增加； 小到中等剂量（每分钟按体重2－10ug/㎏），能直接激动β1受体及间接促使去甲肾上腺素自储藏部位释放，对心肌产生正性应力作用，使心肌收缩力及心搏量增加，最终使心排血量增加、收缩压升高、脉压可能增大，舒张