阿拉明或多巴胺对感染性休克患者血流动力学血乳酸及预后的影响

Effect of alamin or dopamine as initial treatment on hemodynamics,blood lactate and prognosis of patients with septic shock

目的比较感染性休克患者起始应用阿拉明或多巴胺对血流动力学、血乳酸及病死率的影响。方法选择2008年9月至2010年8月广东省人民医院88例感染性休克患者起始应用阿拉明升压治疗37例、多巴胺51例,观察血流动力学、血乳酸、病死率。结果阿拉明组治疗后6 h心率增快[(119.2±12.2)次/min对(136.5±18.3)次/min,P<0.01],平均动脉压(MAP)升高[(36.6±11.0)mmHg对(65.8±17.1)mmHg,P<0.01];多巴胺组治疗后6 h心率增快[(112.2±12.3)次/min对(131.3±16.8)次/min,P<0.01],MAP升高[(39.1±10.9)mmHg对(70.5±17.4)mmHg,P<0.01]。阿拉明组治疗后6 h与治疗前血乳酸差值大于多巴胺组[(-1.07±0.77)mmol/L对(-0.66±0.42)mmol/L,P<0.01];乳酸清除率差异亦有统计学意义[(20.5±14.7)%对(14.4±10.4)%,P<0.05]。结论阿拉明和多巴胺均能有效维持感染性休克患者血流动力学稳定,阿拉明较多巴胺更有效清除血乳酸。

Objective To compare the effect of alamin or dopamine on hemodynamics, blood lactate and mortality as the initial treatment in patients with septic shock. Methods Among 88 patients with septic shock,37 patients （alamin group）were treated with alamin in initial stage, 51 patients （dopamine group ）were treated with dopa- mine. Hemodynamic,lactic acid and mortality of two groups were compared. Results 6 hours after treatment, heart rate of patients in alamin group was higher than before[ （ 119. 2± 12. 2）/rain vs （ 136. 5 ±18.3）/min,P 〈 0. 01 ] ,mean arterial pressure increased[ （36. 6 ±11.0） mmHg vs （65.8 ± 17.1 ） mmHg,P 〈 0. 01 ]. Similarly, heart rate of patients in dopaminc group was higher[ （ 112. 2± 12. 3 ）/min vs （ 131.3± 16. 8 ）/min,P 〈 0. 01 ], mean arterial pressure increased too [ （39. 1 ±10. 9 ）mmHg vs （70. 5 ±17.4 ） mlnHg, P 〈 0. 01 ]. The difference of blood lactate during treatment of alamin group was larger than dopamine group[ （ - 1.07 ＋ 0. 77 ） mmol/L vs （ - 0. 66 ＋ 0. 42）mmol/L, P 〈 0. 01 ] ;lactate clearance rate of alamin group was signifieantly higher than dopamine group [ （20. 5 ±14. 7 ） % vs （ 14.4 ±10.4） % ,P 〈 0.05 ]. Conclusion Alamin and dopamine are both effective to maintain hemodynamic stability in patients with septic shock, and alamin is more effective on clearance of blood lactate than dopamine.