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Einfluss von Dopexamin und Iloprost auf die Plasma-Disappearance-Rate von Indozyaningrün bei Patienten im septischen Schock

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Zusammenfassung

Fragestellung

Der Einfluss von Dopexamin und Iloprost auf die Plasma-Disappearance-Rate (PDR) von Indozyaningrün (ICG) bei Patienten im septischen Schock wurde in einer prospektiven klinischen Studie untersucht.

Methodik

Bei 40 konsekutiven Patienten im septischen Schock wurden ein fiberoptischer Katheter femoralarteriell (COLD-System) sowie eine Tonometermagensonde eingeführt. Die Patienten erhielten entweder Dopexamin (0,5 µg/kg KG/min) oder Iloprost (1 ng/kg KG/min) über 24 h intravenös. Zu den Zeitpunkten 0, 1, 6 und 24 h sowie 1 h nach Ende der Dopexamin- bzw. Iloprostinfusion wurden die PDR, der intramukosale pH der Magenschleimhaut (pHi), der Herzindex (HI) und das intrathorakale Blutvolumen (ITBV) bestimmt.

Ergebnisse

Die PDR war 24 h nach Beginn der Dopexamininfusion signifikant um 45,9% gegenüber dem Ausgangswert erhöht (12,2±1,8%/min vs. 17,8±2,2%/min). Eine Stunde nach Infusionsende fiel die PDR wieder auf Ausgangswerte zurück. Eine Stunde nach Beginn der Iloprostinfusion erhöhte sich die PDR auf 16,4±2,1%/min und stieg 24 h nach Infusionsbeginn auf ein Maximum von 18,6±2,2%/min gegenüber dem Ausgangswert von 13,9±1,7%/min (+33,8%; p<0,05). Nach Ende der Infusion lag die PDR wieder im Bereich des Ausgangsniveaus. Die Ausgangswerte für den pHi lagen in allen Gruppen im Bereich normaler Werte und änderten sich während der Untersuchung nicht. Herzindex und ITBV blieben im Beobachtungszeitraum unverändert. Unter Dopexamingabe konnte die Menge des benötigten Noradrenalins signifikant reduziert werden.

Schlussfolgerungen

Dopexamin und Iloprost haben einen positiven Effekt auf die PDR von ICG und wirken somit protektiv auf die Perfusion im Splanchnikusgebiet bzw. auf die Leberfunktion.

Abstract

Objectives

To evaluate the effect of dopexamine and iloprost on the plasma disappearance rate (PDR) of indocyanine green (ICG) in patients in septic shock in a prospective clinical trial.

Methods

In 40 consecutive patients in septic shock, a femoral arterial fiberoptic catheter (COLD system) and a gastrotonometric probe were placed. Patients received either dopexamine infusion (0.5 µg/kg body weight/min) or iloprost (1 ng/kg body weight/min) for 24 h i.v. PDR, intramucosal pH of stomach wall (pHi), cardiac index (HI) and intrathoracic blood volume (ITBV) were determined before, 1, 6, and 24 h after dopexamine or iloprost infusion and 1 h after end of infusion.

Results

PDR was significantly increased 24 h after starting dopexamine infusion from 12.2±1.8%/min to 17.8±2.2%/min (+45.9%) and 1 h after the end of infusion PDR decreased to baseline values. PDR increased to 16.4±2.1%/min, 1 h after starting iloprost infusion and increased to a maximum value of 18.6±2.2%/min (+33.8%, p<0.05) 24 h after start of infusion compared to the baseline (13.9±1.7%/min). After the end of infusion PDR decreased to baseline values. Baseline values of pHi were in normal ranges in all groups and there was no change during the observation period. Cardiac index and ITBV were stable during the study. Dosage of norepinephrine could be reduced by dopexamine infusion.

Conclusions

Dopexamine and iloprost have a positive effect on the plasma disappearance rate of ICG and therefore have a protective effect on splanchnic perfusion and liver function, respectively.

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Authors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Charité, Campus Charité Mitte, Medizinische Fakultät der Humboldt-Universität zu Berlin

    J. Birnbaum, C. Lehmann, D. Krausch, H. Wauer, C. Spies & W. J. Kox

  2. Klinik für Urologie, Universitätsklinikum Charité, Campus Charité Mitte, Medizinische Fakultät der Humboldt-Universität zu Berlin

    K. Taymoorian

  3. Klinik und Poliklinik für Anästhesiologie und Intensivmedizin, Ernst-Moritz-Arndt-Universität Greifswald

    C. Lehmann & M. Gründling

  4. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Charité, Campus Charité Mitte,Medizinische Fakultät der Humboldt-Universität zu Berlin , 10098 , Berlin

    J. Birnbaum

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  1. J. Birnbaum
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  2. C. Lehmann
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  3. K. Taymoorian
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  8. W. J. Kox
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Correspondence to J. Birnbaum.

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Birnbaum, J., Lehmann, C., Taymoorian, K. et al. Einfluss von Dopexamin und Iloprost auf die Plasma-Disappearance-Rate von Indozyaningrün bei Patienten im septischen Schock. Anaesthesist 52, 1014–1019 (2003). https://doi.org/10.1007/s00101-003-0580-1

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