Comparason Of Impacts Of NE And DA On Early Outcome And Renal Function During Perioperative Stage In Patients Undergoing Cardiovascular Surgery

Objective: the aim of the study was to investigate the effects of norepinephrine and dopamine on renal function and early prognosis in patients undergoing cardiac valve replacement under cardiopulmonary bypass (CPB), in order to privide evidence for rational use of medicine in clinic.Methods: 26 patients undergoing cardiac valve replacement under CPB were randomly assigned to two groups, norepinephrine group (NE group, n = 13) and the dopamine group (DA group, n = 13). All patients were aged 34 ~ 58 years old, . and their cardiac function before operation were 1-2 degree according to New York Heart Association (NYHA) classification. No rheumatoid activity, immune system and other cardiovascular diseases in the patients; as well no diabetes, severe disorders of liver, kidney and blood system in the patients. At the end of CPB, norepinephrine (0.01-0.08μg / kg / min) were given in patients of NE group and dopamine (3-10μg / kg / min) in patients of DA group for maintaince of blood circulation. Mean blood pressure, central venous pressure, heart rate, resuscitation and arrhythmia were observed during and after operation.. The renal function including a 24-hour urine volume, urine creatinine, ejection fraction｛EF(H2O)｝, 24 hours clearance rate of creatinine, urea nitrogen and creatinine of blood were evaluated after operation, as well levels of blood glucose and postoperative complications were monitored..Results: 1. Hemodynamics changes: compared to DA group, incidence of atrioventricular block, atrial fibrillation and ventricular arrhythmia was low after resuscitation (P <0.01), moreover resuscitation rate was high (P<0.01) in patients of NE group. 2.Renal function: there was no difference in levels of urine creatinine, EF (H2O), 24 hours clearance rate of creatinine between groups, no difference in levels of blood urea nitrogen and creatinine postoperatively. The risk of acute renal injury was 4 in NE group, while it was 6.3 in DA group. The levels of blood glucose were elevated comparably in both groups after operation, they were increased first, then decreased, and return to normal after 24 hours.Conclusions: The administration of NE in therapeutic doses reduces incidence of arrhythmia during resuscitation after CPB.The administration of NE in therapeutic doses is not harmful to kidney in patiient undergoing cardiac surgery. Levels of blood glucose are elevated after CPB then gradually return to normal with time.