Zusammenfassung.
Katecholamine steigern nicht nur das Herzzeitvolumen (HZV) und damit das Sauerstoffangebot (D˙O2), sondern auch den Sauerstoffverbrauch (V˙O2). Für die Auswahl eines Katecholamins zur Therapie ist daher von Relevanz, in welchem Verhältnis das HZV zum V˙O2 gesteigert wird, da die O2-Bilanz des Organismus nur durch eine Steigerung des HZV bei möglichst geringem O2-Mehrverbrauch verbessert wird. Unter diesem Blickwinkel untersuchten wir anhand der Literatur die Beziehung zwischen HZV und V˙O2 sowohl am gesunden als auch am erkrankten Organismus und verglichen verschiedene Katecholamine auf der Grundlage der Steilheiten der individuellen Regressionsgeraden ihrer HZV/V˙O2-Beziehung miteinander. Je nach Studienbedingungen variierten allerdings das Ausmaß sowohl der HZV- als auch der V˙O2-Steigerung um ein Vielfaches schon für ein und dieselbe Substanz. Am gesunden Organismus erhöhen die synthetischen Katecholamine (Dobutamin und Dopexamin) bevorzugt das HZV, während die natürlichen Katecholamine (Adrenalin und Noradrenalin) sowohl V˙O2 als auch HZV gleichermaßen steigern. Am erkrankten Organismus ist die Literaturlage ebenfalls nicht einheitlich, dennoch lassen sich tendenziell ähnliche Unterschiede zwischen den Substanzen wie am gesunden Organismus erkennen. Bei zurückhaltender Wertung der verfügbaren Informationen eignen sich unter den vorgenannten Aspekten zur Kreislaufunterstützung vor allem die synthetischen Katecholamine Dobutamin und insbesondere Dopexamin, da sie das Herzzeitvolumen und damit das O2-Angebot über den Stoffwechselbedarf hinaus steigern.
Coupling of Cardiac Output or Systemic O2 Transport with Metabolism during Catecholamine Therapy.
Catecholamines increase cardiac output (CO) and thus systemic oxygen delivery, but they also increase the tissue's oxygen demand (thermogenic or calorigenic effect). Therefore, it is of particular interest for the choice of a catecholamine as to what extent CO is increased in relation to oxygen demand (V˙O2), because the tissue's oxygen balance is improved only if CO and thus oxygen delivery increases more than oxygen demand. For this purpose we reviewed the literature and analysed the relation between CO and V˙O2 during physiological as well as during pathological conditions. In particular, we compared the slopes of the regression lines of the individual CO/V˙O2-relation for each catecholamine. Dependent on study conditions, the extent of the increases in CO and V˙O2 varies substantially already for one and the same agent. During physiological conditions, the synthetic agents dobutamine and dopexamine primarily increase CO, whereas the endogenous ones epinephrine and particularly norepinephrine increase both CO and V˙O2 to about the same extent. During pathological conditions the literature is inconsistent, but it appears that the CO/V˙O2-relations do not differ substantially from those observed under physiological conditions. With due caution the current information implies that the synthetic catecholamines dobutamine and in particular dopexamine might be preferred in the treatment of low cardiac output states because they increase CO and thus oxygen delivery above the increase in metabolic demand.
Schlüsselwörter:
Katecholamine - Kreislauftherapie - Stoffwechsel - Sauerstoffverbrauch - Sauerstofftransport - Adrenalin - Noradrenalin - Dobutamin - Dopexamin
Key words:
Catecholamine therapy - Cardiac output - Metabolism - Oxygen consumption - Oxygen delivery - Epinephrine - Norepinephrine - Dobutamine - Dopexamine
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Priv.-Doz. Dr. T. W. L. Scheeren
Klinik für AnaesthesiologieHeinrich-Heine-Universität
Moorenstraße 5
40225 Düsseldorf
Email: scheeren@uni-duesseldorf.de
