《血流动力学pumch》ppt课件模板.pptVIP

对血管活性药物的评价-3 多巴胺是否具有肾脏保护作用？(1.2) 多巴胺 vs 多巴酚丁胺 前瞻性、随机、双盲研究 自身对照(n = 23) 结论： 两者在pH，电解质，PCWP无差异 多巴酚丁胺具有改善肾脏灌注的作用 多巴胺仅具有利尿作用 2021/7/26 对血管活性药物的评价-4 多巴胺是否具有肾脏保护作用？(2.1) Data sources Studies in all languages MEDLINE search from 1966 to 1999 Study selection clinical trials or meta-analyses evaluating low-dose dopamine ( 5 μg/kg/min) for the prevention or treatment of ARF in humans reporting outcome data for mortality, need for dialysis, or development or worsening of ARF 2021/7/26 对血管活性药物的评价-5 多巴胺是否具有肾脏保护作用？(2.2) Weighted event rates Outcome RCT No. pts dopamine control RRR (95%CI) P value Mortality 11 508 4.9% 5.6% 14% (-66 to 56) 0.69 Development of ARF 11 511 17.9% 19.5% 20% (-14 to 44) 0.50 Need for hemodialysis 10 618 16.2% 16.5% 10% (-21 to 34) 0.86 Kellum JA, Decker JM. Use of dopamine in acute renal failure: a meta-analysis. Crit Care Med. 2001 Aug;29:1526-31 2021/7/26 对血管活性药物的评价-6 多巴胺是否具有肾脏保护作用？(3.1) a multicenter, randomized, double-blind, placebo-controlled study pts with at 2 criteria for SIRS and clinical evidence of early renal dysfunction (oliguria or increase in SCr) 328 ps admitted to 23 ICUs with continuous iv infusion of dopamine 2 ?g/kg/min or placebo primary endpoint peak SCr during the infusion 2021/7/26 对血管活性药物的评价-7 多巴胺是否具有肾脏保护作用？(3.2) Dopamine (n = 161) Placebo (n = 163) P value Peak Scr 245 ? 144 249 ? 147 0.93 Delta Scr 62 ? 107 66 ? 108 0.82 No. of pts with Scr 300 56 56 0.92 No. of pts requiring RRT 35 40 0.55 Duration of ICU stay 13 ? 14 14 ? 15 0.67 Hospital stay 29 ? 27 33 ? 39 0.29 No. of deaths 69 66 Bellomo R, Chapman M, Finfer S, et al. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000 Dec 23-30;356(9248):2139-43 2021/7/26 对血管活性药物的评价-8 去甲肾上腺素与多巴胺的比较 (1.1) 去甲肾上腺素 vs 多巴胺 前瞻性、随机、双盲临床试验 治疗终点： 恢复器官灌注 ＞6 h