多巴胺在冠状动脉介入治疗中急性闭塞合并血液动力学障碍的应用价值(摘要)
作者：马长生 周玉杰 王勇 颜红兵 李宪伦 张晓 郑知刚 李霄 柯元南
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：本文报告在冠状动脉介入治疗中急性闭塞合并血液动力学障碍时应用多巴胺快速静脉输注迅速提高心搏量及血压，支持心脑血流灌注，为及时处理血管并发症、恢复冠状动脉血运赢得时机的体会。
方法：在冠状动脉介入治疗前对于预计发生急性冠状动脉闭塞时将导致严重血液动力学障碍风险较高的患者，常规备用多巴胺注射液(60 mg/100 ml), 经输液器与穿刺股静脉留置的鞘管连接。一旦出现急性冠状动脉闭塞伴严重血液动力学障碍，低血压休克时立即从静脉鞘管输注多巴胺，首剂注射20 mg,根据动脉压力决定维持输注剂量。
结果：605例接受经皮冠状动脉腔内成形术(PTCA)治疗的患者中，多巴胺备用率达57%(345/605例)。发生急性冠状动脉闭塞伴低血压休克者13例，11例病人输注多巴胺动脉血压在2～7分钟内使收缩压回升至≥90 mmHg(1 mmHg=0.133 kPa),使用多巴胺前后收缩压分别为71.2±11.6 mmHg和115.0±7.0 mmHg,血压恢复时间5.2±1.8分，11例患者经快速再次球囊成形(1例)和(或)支架置入(10例)，迅速恢复急性闭塞血管前向血流。多巴胺维持应用时间21.8±9.5分,多巴胺用量60.6±18.9(35～90)mg 。血液动力学恢复稳定,于导管室内撤除多巴胺，所有病人未发生与多巴胺应用相关的心室颤动等并发症。
, 百拇医药
结论：立即经静脉鞘管灌注多巴胺可最为迅速地提高心脏泵功能、提高血压，保持心脑等重要脏器的血流灌注，为处理冠状动脉介入治疗所致的急性并发症及必要时进一步的主动脉内球囊反搏等支持措施赢得时机，是一项重要而可靠的心导管室应急治疗措施。
Application of Dopamine to Acute Occlusion with Hemodynamic Compromise during Coronary Intervention (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhou Yujie, Wang Yong, et al.
Objective: Application of dopamine to increase cardiac output and blood pressure and to win the early opportunity to restore coronary blood flow in acute occlusion with hemodynamic compromise during coronary intervention is reported.
, 百拇医药
Methods: For the patients with high risk of hemodynamic compromise, dopamine (60 mg/100 ml) was prepared and connected to the intravenous sheath during coronary intervention, ready to be infused whenever it was needed.
Results: 57% of 605 patients included in this study were connected with prepared dopamine during PTCA procedure, and 11 of 13 cases with hypotension and shock received prompt dopamine infusion with a result of systolic BP increasing to >90 mmHg making the further interventional therapy possible. Systolic BP pre- and post-infusion was 71.2±11.6 mmHg and 115.0±7.0 mmHg, respectively. The dopamine infusion sustained for 21.8±9.5 min and dosage of dopamine was 60.6±18.9 (35～90) mg. All patients had excellent results without complications.
Conclusion: Application of dopamine is a realible and important method to treat acute complications during coronary intervention., http://www.100md.com
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：本文报告在冠状动脉介入治疗中急性闭塞合并血液动力学障碍时应用多巴胺快速静脉输注迅速提高心搏量及血压，支持心脑血流灌注，为及时处理血管并发症、恢复冠状动脉血运赢得时机的体会。
方法：在冠状动脉介入治疗前对于预计发生急性冠状动脉闭塞时将导致严重血液动力学障碍风险较高的患者，常规备用多巴胺注射液(60 mg/100 ml), 经输液器与穿刺股静脉留置的鞘管连接。一旦出现急性冠状动脉闭塞伴严重血液动力学障碍，低血压休克时立即从静脉鞘管输注多巴胺，首剂注射20 mg,根据动脉压力决定维持输注剂量。
结果：605例接受经皮冠状动脉腔内成形术(PTCA)治疗的患者中，多巴胺备用率达57%(345/605例)。发生急性冠状动脉闭塞伴低血压休克者13例，11例病人输注多巴胺动脉血压在2～7分钟内使收缩压回升至≥90 mmHg(1 mmHg=0.133 kPa),使用多巴胺前后收缩压分别为71.2±11.6 mmHg和115.0±7.0 mmHg,血压恢复时间5.2±1.8分，11例患者经快速再次球囊成形(1例)和(或)支架置入(10例)，迅速恢复急性闭塞血管前向血流。多巴胺维持应用时间21.8±9.5分,多巴胺用量60.6±18.9(35～90)mg 。血液动力学恢复稳定,于导管室内撤除多巴胺，所有病人未发生与多巴胺应用相关的心室颤动等并发症。
, 百拇医药
结论：立即经静脉鞘管灌注多巴胺可最为迅速地提高心脏泵功能、提高血压，保持心脑等重要脏器的血流灌注，为处理冠状动脉介入治疗所致的急性并发症及必要时进一步的主动脉内球囊反搏等支持措施赢得时机，是一项重要而可靠的心导管室应急治疗措施。
Application of Dopamine to Acute Occlusion with Hemodynamic Compromise during Coronary Intervention (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhou Yujie, Wang Yong, et al.
Objective: Application of dopamine to increase cardiac output and blood pressure and to win the early opportunity to restore coronary blood flow in acute occlusion with hemodynamic compromise during coronary intervention is reported.
, 百拇医药
Methods: For the patients with high risk of hemodynamic compromise, dopamine (60 mg/100 ml) was prepared and connected to the intravenous sheath during coronary intervention, ready to be infused whenever it was needed.
Results: 57% of 605 patients included in this study were connected with prepared dopamine during PTCA procedure, and 11 of 13 cases with hypotension and shock received prompt dopamine infusion with a result of systolic BP increasing to >90 mmHg making the further interventional therapy possible. Systolic BP pre- and post-infusion was 71.2±11.6 mmHg and 115.0±7.0 mmHg, respectively. The dopamine infusion sustained for 21.8±9.5 min and dosage of dopamine was 60.6±18.9 (35～90) mg. All patients had excellent results without complications.
Conclusion: Application of dopamine is a realible and important method to treat acute complications during coronary intervention., http://www.100md.com