Influences of dopamine and norepinephrine on hemodynamic parameters in patients with postpartum hemorrhage

WANG Zhu-heng; SUN Li-ping; LI Yu-wei; SHI Chun-zhi; ZHOU Jian-xin; ZHOU Guan-hua

摘要：Background Postpartum hemorrhage,a severe complication during delivery,is one of the leading causes of maternal death.Dopamine and norepinephrine are widely used as first-line therapy.This study aimed at comparing their effects on hemodynamics.Methods A perspective,randomized,parallel-group study was performed.The patients were randomly divided into a dopamine group (maximum dose ≤ 20 μg·kg-1· min-1) and a norepinephrine group (maximum dose ≤ 0.2 μg· kg-1· min-1).Both treatments increased the mean arterial pressure (MAP) to more than 70 mmHg.PiCCO was used for monitoring hemodynamic parameters,lactic acid and urine output.Results A total of 73 patients were enrolled in this study.Thirty seven patients were assigned to the dopamine group,36 patients to the norepinephrine group.Average MAP was increased from 55.2±5.22 mmHg to 71.4±4.67 in dopamine group,and from 54.8±5.87 mmHg to 72.2±4.67 in norepinephrine group.MAP showed a significant increase before and after treatment in both groups (P＜0.001),but no significant difference was found between the two groups (P=0.425).After 6 hours of treatment,the average heart rate (101±9.81) and cardiac output index (CI,2.40±0.40 L· min-1· m-2) in the norepinephrine group were lower than those of the dopamine group (120±16.7 and 3.01±0.38 L· min-1·m-2,P＜0.001) The global ejection fraction (GEF,43.9±3.32％) and systemic vascular resistance index (SVRI,3763±229.9 dynes· s· m-2· cm-5) of the norepinephrine were higher than those in the dopamine group (37.4±4.77％,2613±235.6 dynes· s· m2· cm-5,P＜0.001).There was a significant difference in urine output between the norepinephrine group (117±17.4 mL/h) and dopamine group (70.7±11.8 mL/h).Conclusions In patients with postpartum hemorrhage,norepinephrine improves the MAP mainly by increasing the myocardial contraction force and the renal perfusion.Therefore,it is recommended as the first choice for the treatment of these patients.