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Anesthesia,Joyful Life

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dopamine 無形的殺手

Dopmaine 是使用最廣的強心增壓藥物,主要理論根據,有alfa, beta, 與 dopanergic  receptors的作用,好像是一個萬金油,大家都知道,什麼都有,就是什麼都沒有,世界上還沒有出現一種十全十美的藥物,所以在renal protection 為實驗研究所否認後,dopamine就沒有什麼優勢,在強心方面,沒有比其他inotropic來的優勢,在vasopressor方面,也比純alga agoinst弱,如果要達到升壓的目的,心跳,也毫無例外的會升高,在critical care 領域,非常忌諱心跳太快!

在一兩年前,大陸一位在美職業的陶醫師,在丁香園大聲疾呼,『多巴銨,無形的殺手』,引發極大的迴響,當然是貶大於褒,攻擊大於信服。今天m&m,一些septic shock的病人,開完刀,48小時內很快的死亡,當然是離不開有dopamine的治療,dopamine不是不能用,但要知道limintation,而不是一昧的提高劑量,也不是一味要用到矇,除了審因對症外,還要選擇不同的inotropics 或 vasopressor。

以下就抄錄陶醫師的大作:『多巴銨,無形的殺手』

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