摘要
目的探讨多巴胺（DA）及去甲肾上腺素（NE）在治疗脓毒性休克过程中对血流动力学及组织氧合的影响。方法选择脓毒性休克患者16例，按随机原则分别给予DA（DA组）或NE（NE组）升压治疗，分别于观察1、2、3和4h末检测血流动力学指标[心率（HR）、平均动脉压（MAP）、心排血指数（CI）、每搏指数（SI）、体循环阻力指数（SVRI）、心脏加速指数（ACI）、左室作功指数（LCWI）、胸腔内液体水平（TFC）]，混合静脉血氧饱和度（SvO2），血乳酸（Lac）及每小时尿量（UV）；于4h末测定肌酐清除率（CCr）。结果①两组各时间点MAP、SI及TFC比较差异均无统计学意义；而LCWI于2h末显示差异有统计学意义（P=0．031）。DA组的HR、CI及ACI明显高于NE组，而SVRI明显低于NE组（P〈0．05或P〈0．01）。说明DA及NE均有很好的升压效果；DA在增加全身氧输送方面优于NE，但使HR加快的作用可能在一定程度上限制了其使用。②两组各时间点SvO2比较差异无统计学意义；而DA组的血Lac水平明显高于NE组（P均〈0．05）。说明在增加内脏灌注及组织氧合方面，NE可能优于DA。③DA组各时间点的uV明显高于NE组（P〈0．05或P〈0．01）。DA组于4h末CCr明显高于NE组（P=0．023），说明DA有明显增加尿量及CCr的作用，对肾功能可能有一定的保护作用。结论对于有少尿和（或）肾功能不全的脓毒性休克患者，应用DA可能是较好的选择，而对于有快速型心律失常或组织缺氧严重的脓毒性休克患者NE可能是更好的选择。
Objective To evaluate the effects of dopamine （DA） and norepinephrine （NE） on hemodynamics and tissue oxygenation of patients with septic shock. Methods Sixteen patients with septic shock were assigned to the groups of DA and NE randomly. They were given DA or NE for 4 hours, then shifted to NE or DA. Heart rate （HR）, mean artery pressure （MAP）, cardiac index （CI）, stroke index （SI）, systemic vascular resistance index （SVRI）, acceleration index （ACI）, left cardiac work index （LCWI）, thoracic fluid content （TFC）, mixed venous oxygen saturation （SvOe）, venous lactate concentration （Lac）, and urine volume per hour （UV） were measured at the end of the 1st, 2nd, 3rd, and 4th hour of the treatment for each of the two drugs. Creatinine clearance rate （CCr） was measured at the end of the 4th hour of study. The differences of all parameters were compared between the two groups. Results ①There were no differences in MAP, SI and TFC between the two groups （P〉0.05）, and there was significant difference in LCWI between the two groups at the end of the 2nd hour （P=0. 031）. HR, CI and ACI were higher while SVRI was lower in DA group than that in NE group, with significant differences between the two groups （P〈0.05 or P〈0.01）. The results suggested that both DA and NE had good .effect on raising blood pressure; DA was more effective than NE in increasing oxygen delivery （DO2）, but its use was confined to certain extent due to its effect of accelerating HR. ② There were no significant differences of SvO2 between the two groups （P〉0. 05）, and the levels of Lae in the group of DA were significantly higher than those in the group of NE （all P〈0.05）. The results suggested that NE was better than DA in improving internal organ perfusion and tissue oxygenation. ③UV in the group of DA was significantly higher than that in the group of NE at different time points （P〈0.05 or P〈0.01）. CCr at the end of the 4th hour in DA group was significant higher than that in NE group （P= 0. 023）. The results suggested that DA had significant effects in increasing urine and CCr, denoting that it might have an effect in protecting renal function. Conclusion DA has better effect of increasing DO2 than NE, but its side effect of accelerating HR may to some degree restrict its use. NE may has better effects than DA on enhancing visceral perfusion and tissue oxygenation. DA may be a better choice for patients with septic shock accompanied by oliguria and/or renal dysfunction. NE may be a better choice for the patients of septic shock with taehyeardia and/or severe tissue hypoxia.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2008年第1期18-22,共5页
Chinese Critical Care Medicine
