PDF(Pubmed)
Abstract：
Background Fenoldopam is a short-acting dopamine A1 receptor agonist which mediates vasodilation of the renal arteries, thereby increasing urine output. The objective of this study was to compare the effects of fenoldopam and its synergistic effect on furosemide for improving the urine output in postoperative critically ill patients with acute kidney injury (AKI). Methods This is a retrospective study of postoperative critically ill patients with AKI. Patients who received furosemide (control group) were compared with those who received furosemide plus fenoldopam (treatment group) and evaluated at 12 and 24 hours post-treatment. Patients with oliguria and AKI were included in the study, while patients with chronic kidney disease (CKD) were excluded. Glomerular filtration rate, serum creatinine, blood pressure, calculated fluid accumulation, fluid intake, urine output, and total fluid output were used as variables to assess the medication effect. Results Of the 126 patients who met the inclusion and exclusion criteria, 87 patients received furosemide alone, and 39 patients received furosemide plus fenoldopam during their first 24 hours of admission to the surgical intensive care unit (SICU). Although not statistically significant, the addition of fenoldopam demonstrated an increase in mean urine output of 1525ml (IQR; 1530-2095) in the first 24 hours (P=0.06). There was also noted an increase in the urine output (p= 0.07) and a decrease in the total fluid accumulation when fenoldopam was co-administered with furosemide when compared to the patients who were only treated with furosemide (p=0.06). There was no significant change in creatinine clearance from baseline in either group. Conclusion Fenoldopam may increase urine output in postoperative critically ill patients with acute kidney injury when administered within the first 24 hours of presentation. Based on our results, fenoldopam appears to have a synergistic effect with furosemide in our study population.
摘要：
背景非诺多泮是一种短效多巴胺A1受体激动剂，可介导肾动脉的血管舒张，从而增加尿量。本研究的目的是比较非诺多泮及其对呋塞米的协同作用，以改善术后危重患者急性肾损伤（AKI）的尿量。方法回顾性分析AKI术后危重患者的临床资料。将接受呋塞米的患者（对照组）与接受呋塞米加非诺多泮的患者（治疗组）进行比较，并在治疗后12和24小时进行评估。少尿和AKI患者被纳入研究，而慢性肾脏病（CKD）患者被排除在外。肾小球滤过率,血清肌酐,血压,计算的流体积聚，液体摄入,尿量,和总液体输出被用作评估药物效果的变量。结果在符合纳入和排除标准的126例患者中,87例患者单独接受呋塞米，39例患者在进入外科重症监护病房(SICU)的前24小时内接受了呋塞米联合非诺多泮治疗.虽然没有统计学意义，添加非诺多巴后,前24小时平均尿量增加1525ml(IQR;1530-2095)(P=0.06).与仅接受呋塞米治疗的患者相比，当非诺多泮与呋塞米共同给药时，还注意到尿量增加（p=0.07）和总液体积聚减少（p=0.06）。两组肌酐清除率均无明显变化。结论非诺多巴在术后急性肾损伤患者出现后24h内给药可增加尿量。根据我们的结果,在我们的研究人群中，非诺多泮似乎与呋塞米具有协同作用。
