| 【Objective】The aim of the study was to investigate the effects of dopamine and epinephrine on oxygen metabolism after cardiac resuscitation and renal function during perioperative stage in patients in open heart surgery under cardiopulmonary bypass.【Methods】Patients undergoing cardiac valve replacement under CPB were randomly assigned to two groups, dopamine group(Group D) and epinephrine group(Group E). All patients were aged 18~70 years old, and their cardiac function before operation were Ⅱ~Ⅲdegree according to New York Heart Association(NYHA) classification. No serious endocrine diseases; without pacemaker before surgery; no severe renal failure; no two operation; no ascending aortic lesion.50 patients fit the criteria were assigned to dopamine group(Group D,n=25) and epinephrine group(Group E,n=25). At the end of CPB,dopamine(3~8 μg/kg/min) in patients of group D and epinephrine(0.03~0.06 μg/kg/min)in patients of group E were given for maintenance of blood circulation. Heart Rate(HR),Mean Blood Pressure(MBP), Central Venous Pressure(CVP), Stroke Volume Index(SVI),Cardiac Index(CI), Oxygen Delivery Index(DO2I), Oxygen Consumption Index(VO2I),Oxygen Extraction Ratio(O2ER), Central Venous Oxygen Saturation(Sc VO2), Lactic acid(Lac) were observed before anesthesia induction(T0), at the end of CPB(T1), 30 minutes after CPB(T2), 1 hour after CPB(T3), and at the end of surgery(T4). Levels of Lac were also been recorded at 6 hour after operation(T5) and 24 hour after operation(T6). 24 hour urine volume, Blood Urea Nitrogen(BUN), Serum Creatinine(Scr) and renal damage index were evaluated after operation.【Results】1. There were no significantly differences between two groups in age, sex, BSA, left ventricular ejection fraction, cardiopulmonary flow time, operation time, the cardiac function classification, and the types of surgery(P>0.05).2. Hemodynamics variables: There are no difference between group D and E comparison of HR, BP and CVP(P>0.05); The SVI of group D and E at T3 and T4 were(31.4±6.0,33.4±6.1),(40.0±6.8,42.7±7.6), group E was significantly higher than group D(P<0.05); Compared with T0, SVI of group D from T1~T4, group E from T1~T3significantly decreased(P<0.05); The CI of group D and E from T1~T4 were(2.3±0.6,2.4±0.5,2.9±0.7,3.1±0.6),(2.6±0.8,2.8±0.6,3.3±0.4,3.6±0.6), group E was significantly higher than group D(P<0.05); Compared with T0, CI of group D from T1~T3 significantly decreased than T0(P<0.05); CI of group E at T1 and T2 significantly decreased than T0(P<0.05), but T4 was significantly higher(P<0.05).3. Oxygen metabolism index: There were no significantly differences between two groups in DO2 I, VO2 I, O2 ER and Sc VO2 from T0~T4(P>0.05); Compared with T0, both DO2 I and VO2 I of the two groups significantly decreased from T1~T4(P<0.05); The levels of Lac in the two groups from T1~T6 significantly increased compared with T0(P<0.05);The overall trend was high in the first and then gradually reduced to normal 24 h after the operation, there were no significantly differences between two groups(P>0.05).4. Renal function: Compared with the preoperative groups, the postoperative groups in Scr and BUN were significantly higher(P<0.05); there were no significantly differences between two groups in Scr,BUN and renal damage index(P>0.05).【Conclusion】1. Infusion of epinephrine continuously after cardiac surgery can able to maintain a higher heart index than dopamine, both not increase the body’s oxygen consumption.2. There were no significantly differences between dopamine and epinephrine in perioperative renal function in patients undergoing cardiac valve replacement with cardiopulmonary bypass. |
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