多巴胺在肾移植术中临床应用价值的再认识

钟羽琦; 王於尘; 苗芸

doi:10.3969/j.issn.1674-7445.2024030

多巴胺在肾移植术中临床应用价值的再认识

doi: 10.3969/j.issn.1674-7445.2024030

*.
510060　广州，中山大学肿瘤防治中心麻醉科
2.
南方医科大学南方医院器官移植科

基金项目: 国家自然科学基金（82270784、82070770）；广东省基础与应用基础研究基金（2023A1515012276）；广东省学位与研究生教育创新计划项目（2022JDXM031）

详细信息

通讯作者:
苗芸（ORCID 0000-0003-3592-4695），博士，主任医师，研究方向为肾移植，Email: miaoyunecho@126.com

中图分类号: R617, R347
计量
- 文章访问数: 45
- HTML全文浏览量: 39
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2024-02-25
- 网络出版日期: 2024-04-28
- 刊出日期: 2024-07-15

Re-understanding of the clinical application value of dopamine in kidney transplantation

*.
Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China

More Information

Corresponding author: Miao Yun, Email: miaoyunecho@126.com

摘要

摘要: 多巴胺是去甲肾上腺素生物合成的前体，小剂量多巴胺主要兴奋多巴胺受体，可扩张肾及肠系膜血管，增加肾血流量，改善微循环。近年来，小剂量多巴胺以其血管活性作用广泛应用于肾移植领域。然而，随着循证医学的发展，多巴胺在肾移植术中保护移植肾灌注功能的作用开始受到人们的质疑。多项研究发现多巴胺在肾移植术中对肾功能、心功能无明显益处，升压效能较低，甚至会增加围手术期并发症的发生风险，而去甲肾上腺素可成为一种较安全的替代。因此，本文就多巴胺在肾移植术中对肾功能、心功能以及血流动力学影响的新进展进行综述，以期为多巴胺在肾移植术中的临床应用提供参考。
- 肾移植 /
- 血管活性药物 /
- 多巴胺 /
- 小剂量 /
- 去甲肾上腺素 /
- 肾灌注 /
- 心律失常 /
- 急性肾损伤
Abstract: Dopamine is the precursor of biosynthesis of norepinephrine. Low-dose dopamine mainly excites dopamine receptors, which may dilate renal and mesenteric vessels, increase renal blood flow and improve the microcirculation. In recent years, low-dose dopamine has been widely applied in the field of kidney transplantation due to its vasoactive effect. However, with the development of evidence-based medicine, the role of dopamine in protecting the perfusion function of renal allograft in kidney transplantation has been questioned. Multiple studies have shown that dopamine brings no significant benefit to renal and cardiac function in kidney transplantation, exerts low pressor effect, and may even increase the risk of perioperative complications. Norepinephrine may be used as a safe substitute. In this article, recent progress in the effect of dopamine upon renal and cardiac function and hemodynamics during kidney transplantation was reviewed, aiming to provide reference for clinical application of dopamine in kidney transplantation.
- Kidney transplantation /
- Vasoactive drug /
- Dopamine /
- Low dose /
- Norepinephrine /
- Renal perfusion /
- Arrhythmias /
- Acute kidney injury

HTML全文

FIG. 3263. FIG. 3263.

FIG. 3263.. FIG. 3263.

下载: 全尺寸图片幻灯片

参考文献(39)

[1]	JOZWIAK M, GERI G, LAGHLAM D, et al. Vasopressors and risk of acute mesenteric ischemia: a worldwide pharmacovigilance analysis and comprehensive literature review[J]. Front Med (Lausanne), 2022, 9: 826446. DOI: 10.3389/fmed.2022.826446.
[2]	NEUMANN J, HOFMANN B, DHEIN S, et al. Role of dopamine in the heart in health and disease[J]. Int J Mol Sci, 2023, 24(5): 5042. DOI: 10.3390/ijms24055042.
[3]	EVANS L, RHODES A, ALHAZZANI W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Crit Care Med, 2021, 49(11): e1063-e1143. DOI: 10.1097/CCM.0000000000005337.
[4]	韩传宝, 钱燕宁. 多巴胺肾保护及抗休克作用的再认识[J]. 临床麻醉学杂志, 2016, 32(3): 306-308. HAN CB, QIAN YN. Further understanding of dopamine's renal protection and anti shock effects[J]. J Clin Anesthesiol, 2016, 32(3): 306-308.
[5]	BITTON E, ZIMMERMAN S, AZEVEDO LCP, et al. An international survey of adherence to Surviving Sepsis Campaign Guidelines 2016 regarding fluid resuscitation and vasopressors in the initial management of septic shock[J]. J Crit Care, 2022, 68: 144-154. DOI: 10.1016/j.jcrc.2021.11.016.
[6]	GUARINO M, PERNA B, CESARO AE, et al. 2023 update on sepsis and septic shock in adult patients: management in the emergency department[J]. J Clin Med, 2023, 12(9): 3188. DOI: 10.3390/jcm12093188.
[7]	JOZWIAK M. Alternatives to norepinephrine in septic shock: which agents and when?[J]. J Intensive Med, 2022, 2(4): 223-232. DOI: 10.1016/j.jointm.2022.05.001.
[8]	GOLDBERG LI, MCDONALD RH JR, ZIMMERMAN AM. Sodium diuresis produced by dopamine in patients with congestive heart failure[J]. N Engl J Med, 1963, 269: 1060-1064. DOI: 10.1056/NEJM196311142692003.
[9]	MCNAY JL, MCDONALD RH JR, GOLDBERG LI. Direct renal vasodilatation produced by dopamine in the dog[J]. Circ Res, 1965, 16: 510-517. DOI: 10.1161/01.res.16.6.510.
[10]	李佳男, 王洪乾, 张铁铮. 多巴胺肾保护作用及其在感染性休克救治中的新发现[J]. 国际麻醉学与复苏杂志, 2017, 38(3): 259-262,285. DOI: 10.3760/cma.j.issn.1673-4378.2017.03.014. LI JN, WANG HQ, ZHANG TZ. New findings of dopamine in renal protection and treatment of septic shock[J]. Inter J Anesthesiol Resusc, 2017, 38(3): 259-262,285. DOI: 10.3760/cma.j.issn.1673-4378.2017.03.014.
[11]	DE DONATO A, BUONINCONTRI V, BORRIELLO G, et al. The dopamine system: insights between kidney and brain[J]. Kidney Blood Press Res, 2022, 47(8): 493-505. DOI: 10.1159/000522132.
[12]	SCHENARTS PJ, SAGRAVES SG, BARD MR, et al. Low-dose dopamine: a physiologically based review[J]. Curr Surg, 2006, 63(3): 219-225. DOI: 10.1016/j.cursur.2005.08.008.
[13]	DALTON RS, WEBBER JN, CAMERON C, et al. Physiologic impact of low-dose dopamine on renal function in the early post renal transplant period[J]. Transplantation, 2005, 79(11): 1561-1567. DOI: 10.1097/01.tp.0000158431.81676.c4.
[14]	LAUSCHKE A, TEICHGRÄBER UK, FREI U, et al. 'Low-dose' dopamine worsens renal perfusion in patients with acute renal failure[J]. Kidney Int, 2006, 69(9): 1669-1674. DOI: 10.1038/sj.ki.5000310.
[15]	傅丹云, 姚俊岩. 低剂量多巴胺对肾功能影响的新进展[J]. 国际麻醉学与复苏杂志, 2015, 36(2): 152-156. DOI: 10.3760/cma.j.issn.1673-4378.2015.02.014. FU DY, YAO JY. Advancement about the effect of low-dose dopamine on renal function[J]. Inter J Anesthesiol Resusc, 2015, 36(2): 152-156. DOI: 10.3760/cma.j.issn.1673-4378.2015.02.014.
[16]	MCMICHAEL LC, GULYANI A, CLAYTON PA. Assessing survival post-kidney transplantation in Australia: a multivariable prediction model[J]. Nephrology (Carlton), 2024, 29(3): 143-153. DOI: 10.1111/nep.14257.
[17]	SLAGTER JS, OUTMANI L, TRAN KTCK, et al. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: a systematic review and meta-analyses[J]. Int J Surg, 2022, 99: 106264. DOI: 10.1016/j.ijsu.2022.106264.
[18]	TERRITO A, BAJEOT AS, MESNARD B, et al. Open versus robotic-assisted kidney transplantation: a systematic review by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Kidney Transplant Working Group[J]. Actas Urol Esp (Engl Ed), 2023, 47(8): 474-487. DOI: 10.1016/j.acuroe.2023.03.003.
[19]	CIAPETTI M, DI VALVASONE S, DI FILIPPO A, et al. Low-dose dopamine in kidney transplantation[J]. Transplant Proc, 2009, 41(10): 4165-4168. DOI: 10.1016/j.transproceed.2009.08.058.
[20]	ZHANG X, HU Y, LUO T. Low-dose dopamine for renal transplantation: a brief PRISMA-compliant meta-analysis[J]. J Clin Anesth, 2020, 67: 110031. DOI: 10.1016/j.jclinane.2020.110031.
[21]	BAQUERO A, MORRIS M, OM A, et al. Dopamine and furosemide infusion for prevention of post-transplant oliguric renal failure [J]. Dial Transplant, 1987.
[22]	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[J]. Lancet, 2000, 356(9248): 2139-2143. DOI: 10.1016/s0140-6736(00)03495-4.
[23]	KELLUM JA, M DECKER J. Use of dopamine in acute renal failure: a meta-analysis[J]. Crit Care Med, 2001, 29(8): 1526-1531. DOI: 10.1097/00003246-200108000-00005.
[24]	PONTICELLI C, REGGIANI F, MORONI G. Delayed graft function in kidney transplant: risk factors, consequences and prevention strategies[J]. J Pers Med, 2022, 12(10): 1557. DOI: 10.3390/jpm12101557.
[25]	SHARMA A, RUCH B, ALWATARI Y, et al. Dissection of external iliac artery during pediatric en bloc kidney transplant: successful rescue and reimplant[J]. Exp Clin Transplant, 2022, 20(5): 526-530. DOI: 10.6002/ect.2021.0150.
[26]	中华医学会器官移植学分会. 中国肾移植麻醉技术操作规范(2019版)[J/OL]. 中华移植杂志(电子版), 2020, 14(1): 17-20. DOI: 10.3877/cma.j.issn.1674-3903.2020.01.005. Branch of Organ Transplantation of Chinese Medical Association. Chinese renal transplantation anesthesia technical operation standards (2019 edition) [J/OL]. Chin J Transplant (Electr Edit), 2020, 14(1): 17-20. DOI: 10.3877/cma.j.issn.1674-3903.2020.01.005.
[27]	KIM H, JUNG H. Considerations regarding anesthesia for renal transplantation[J]. Anesth Pain Med (Seoul), 2024, 19(1): 5-11. DOI: 10.17085/apm.23153.
[28]	ZHU B, JIANG J, YU H, et al. Effect of norepinephrine, vasopressin, and dopamine for survivals of the elderly with sepsis and pre-existing heart failure[J]. Sci Rep, 2024, 14(1): 1948. DOI: 10.1038/s41598-024-52514-5.
[29]	JIA L, WANG P, LI C, et al. The efficacy and safety of vasopressors for septic shock patients: a systemic review and network meta-analysis[J]. Shock, 2023, 60(6): 746-752. DOI: 10.1097/SHK.0000000000002193.
[30]	BYRNE SE, VISHWAKARMA N, SRIRAMULA S, et al. Dopamine receptor 3: a mystery at the heart of cardiac fibrosis[J]. Life Sci, 2022, 308: 120918. DOI: 10.1016/j.lfs.2022.120918.
[31]	陈钊军. 小剂量去甲肾上腺素在肾移植术中的应用[J]. 实用医学杂志, 2006, 22(10): 1200-1201. DOI: 10.3969/j.issn.1006-5725.2006.10.048. CHEN ZJ. Application of low-dose norepinephrine in renal transplantation surgery[J]. J Pract Med, 2006, 22(10): 1200-1201. DOI: 10.3969/j.issn.1006-5725.2006.10.048.
[32]	RUSLAN MA, BAHARUDDIN KA, NOOR NM, et al. Norepinephrine in septic shock: a systematic review and meta-analysis[J]. West J Emerg Med, 2021, 22(2): 196-203. DOI: 10.5811/westjem.2020.10.47825.
[33]	NANDKEOLYAR S, RYU R, MOHAMMAD A, et al. A review of inotropes and inopressors for effective utilization in patients with acute decompensated heart failure[J]. J Cardiovasc Pharmacol, 2021, 78(3): 336-345. DOI: 10.1097/FJC.0000000000001078.
[34]	DE BACKER D, CECCONI M, CHEW MS, et al. A plea for personalization of the hemodynamic management of septic shock[J]. Crit Care, 2022, 26(1): 372. DOI: 10.1186/s13054-022-04255-y.
[35]	BURNIER M, DAMIANAKI A. Hypertension as cardiovascular risk factor in chronic kidney disease[J]. Circ Res, 2023, 132(8): 1050-1063. DOI: 10.1161/CIRCRESAHA.122.321762.
[36]	JONES TW, SMITH SE, VAN TUYL JS, et al. Sepsis with preexisting heart failure: management of confounding clinical features[J]. J Intensive Care Med, 2021, 36(9): 989-1012. DOI: 10.1177/0885066620928299.
[37]	NA SJ, YANG JH, KO RE, et al. Dopamine versus norepinephrine as the first-line vasopressor in the treatment of cardiogenic shock[J]. PLoS One, 2022, 17(11): e0277087. DOI: 10.1371/journal.pone.0277087.
[38]	SCHNUELLE P, SCHMITT WH, WEISS C, et al. Effects of dopamine donor pretreatment on graft survival after kidney transplantation: a randomized trial[J]. Clin J Am Soc Nephrol, 2017, 12(3): 493-501. DOI: 10.2215/CJN.07600716.
[39]	SCHNUELLE P, DRÜSCHLER K. Low-dose dopamine for renal transplantation: gain of knowledge through pooled data analysis?[J]. J Clin Anesth, 2021, 70: 110196. DOI: 10.1016/j.jclinane.2021.110196.