Função renal e hemodinâmica durante a administração de dopamina em doses baixas em pacientes gravemente enfermos
Palavras-chave:
Dopamina, Processos hemodinâmicos, Unidades de Terapia Intensiva, Diurese, DiuréticosResumo
CONTEXTO: Apesar do grande número de trabalhos sobre os efeitos renais e hemodinâmicos de doses baixas de dopamina em pacientes graves, ainda existe muita controvérsia a respeito. OBJETIVOS: Esse estudo objetivou avaliar os efeitos de dopamina (2 mcg/kg/min) na hemodinâmica (máxima pressão arterial média, PAM, freqüência cardíaca máxima, FR, pressão venosa central, PVC, clearance de creatinina, CLcr, diurese e fração de excreção de sódio, FENa+ ). TIPO DE ESTUDO: Estudo clínico não randomizado, aberto, prospectivo. LOCAL: Uma unidade de terapia intensiva em hospital universitário terciário. PARTICIPANTES: 22 pacientes com estabilidade hemodinâmica admitidos na Unidade. PROCEDIMENTOS: Os pacientes foram submetidos a três períodos de duas horas de duração cada um: sem dopamina (P1), com dopamina (P2) e sem dopamina (P3). PRINCIPAIS VARIÁVEIS ESTUDADAS: As variáveis acima mencionadas foram medidas em cada um dos períodos. CLcr foi medido baseado na fórmula U.V/P, onde U é a creatinina urinária (mg/dl), V é a diurese em ml/min e P é a creatinina sérica (mg/dl). FENa+ foi calculado baseado na fórmula: sódio urinário (mEq/l) x P/sódio plasmático (mEq/l) x U) x 100. Os resultados foram apresentados como média e desvio padrão. O teste t de Student foi utilizado e os resultados considerados significativos se o valor de p fosse menor que 0,05. RESULTADOS: 12 pacientes (sete homens e cinco mulheres) foram incluídos, com a idade média de 55.45 anos. Não houve nenhuma variação na PAM, FR, PVC, CLcr ou FENa+ com o uso de dopamina na dose de 2 mcg/kg/min. Entretanto, a diurese aumentou significativamente no P2, de 225.4 para 333.9 ml. CONCLUSÕES: A infusão de 2 mcg/kg/min de dopamina durante duas horas aumenta a diurese. Nas doses estudadas, a dopamina não induziu alterações significativas na PAM, FR, PVC, CLcr e FENa+.
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