间羟胺与去甲肾上腺素对老年脓毒性休克患者疗效的比较

Comparison of effects of metaraminol and norepinephrine on elderly patients with septic shock

目的比较间羟胺与去甲肾上腺素对老年脓毒性休克患者的临床疗效。方法在这个多中心前瞻性队列研究中,老年脓毒性休克患者分为间羟胺组(n=100)及去甲肾上腺素组(n=100);观察28 d生存情况及平均住院天数、血流动力学指标及肾脏功能。结果间羟胺组平均住院天数低于去甲肾上腺素组(P<0.05);两组间血压、心率、动脉血乳酸、B型钠尿肽、左室射血分数和28 d生存率的差异无统计学意义(P>0.05);用升压药第3和7天间羟胺组平均尿量高于去甲肾上腺素组(均P<0.05),用升压药第3、7和14天间羟胺组尿素氮低于去甲肾上腺素组(均P<0.05),用升压药第7和14天间羟胺组肌酐和血液净化治疗率均低于去甲肾上腺素组(P<0.05)。结论间羟胺在改善老年脓毒性休克患者的28d生存率及血流动力学的作用与去甲肾上腺素相近,但在降低平均住院天数、肾功能保护方面优于去甲肾上腺素。

Objective To compare the effect of metaraminol and norepinephrine(NA)on elderly patients with septic shock.Methods In this multicenter prospective cohort study elderly patients with septic shock were divided into the metaraminol group(n=100)and NA group(n=100).The 28-day survival and average hospital stay,the hemodynamics and renal function of the patients were observed.Results The average hospital stay in the metaraminol group was lower than that in the NA group(P<0.05).Blood pressure,heart rate,arterial lactate,B-type natriuretic peptide,left ventricular ejection fraction and 28-day survival had no significant differences between the two groups(all P>0.05).The average urine output at day 3 and 7 after the administration of vasopressor in the metaraminol group were higher than those in the NA group(all P<0.05),blood urea nitrogen at day 3,7 and 14 after the administration of vasopressor in the metaraminol group were lower than those in the NA group(all P<0.05),and the creatinine at day 3,7 and 14 after the administration of vasopressor and the rate of renal replacement therapy in the metaraminol group were lower than those in the NA group(all P<0.05).Conclusions Metaraminol has similar effect to norepinephrine in improving 28-day survival and hemodynamics of elderly patients with septic shock,but is superior to norepinephrine in reducing the average hospital stay and protecting renal function.