比较多巴胺与去甲肾上腺素对感染性休克血流动力学和氧代谢的影响

Comparative study of dopamine and norepinephrine in patients with infectious shock:Effect on hemodynamic and oxygen metabolism

目的比较多巴胺与去甲肾上腺素对感染性休克患者血流动力学和氧代谢的影响。方法44例早期感染性休克患者经过充足的液体复苏使肺动脉楔压(PAWP)维持在1.6～2kPa之间,随机分为多巴胺组(Dopa组)和去甲肾上腺素组(NE组)。分别加用多巴胺或去甲肾上腺素,使平均动脉压(MAP)维持>10.7kPa。分别测定并计算应用多巴胺或去甲肾上腺素前(T0)、用药后1h(T1)、4h(T2)、8h(T3)、16h(T4)、24h(T5)和48h(T6)各个时间点的血流动力学指标[包括心率(HR)、外周血管阻力指数(SVRI)、心脏指数(CI)、肺动脉楔压(PAWP)及平均肺动脉压(MPAP)]和氧和指标[包括氧供指数(DO2I)、氧耗指数(VO2I)及氧摄取率(O2ext)]。结果(1)用药后2组同一时间点的HR、CI相比,NE组显著低于Dopa组(P<0.05);NE组的SVRI明显高于Dopa组(P<0.05)。(2)Dopa组的DO2I比NE组明显增加(P<0.05),NE组的VO2I、O2ext和Dopa组同一时间点相比明显增高(P<0.05)。结论对于早期感染性休克患者,去甲肾上腺素比多巴胺能更好的维持血流动力学稳定,它可以增加脏器灌注,提高O2ext,改善氧代谢。

Objective To investigate the effect on hemodynamic and oxygen metabolism in patients with infectious shock treated with dopamine and norepinephrine.Methods Totally 44 cases with infectious shock underwent the sufficiently fluid infusion and the PAWP was kept between 1.6～2 kPa.The cases were divided into Dopa group,which treated with dopamine,and NE group,which treated with norepinephrine.The mean arterial pressure was kept more than 10.7 kPa.A series indexes including HR,SVRI,CI,PAWP,MPAP,DO2I,VO2I and O2ex...