血管活性药物对脓毒症患者肝肾功能的影响

Clinical analysis of the effect of vasoactive agents on the liver and renal function in septic patients

目的:探讨血管活性药物对脓毒症患者肝肾功能的影响。方法:回顾性研究1997年1月至2001年6月外科ICU内使用血管活性药物超过4天的脓毒症患者,记录用药前一天的APACHEⅡ评分、体循环平均血压等资料。分为大剂量多巴胺组、去甲肾上腺素合用小剂量多巴胺或多巴酚丁胺组及小剂量多巴胺或多巴酚丁胺组,比较用药前后血肌酐及总胆红素的变化。结果:大剂量多巴胺组血肌酐及总胆红素显著增高(P<0.05)。去甲肾上腺素伍用小剂量多巴胺或多巴酚丁胺对血肌酐及总胆红素无显著影响。单用小剂量多巴胺或多巴酚丁胺可使血肌酐显著降低,但用药前后血总胆红素无显著差异。结论:使用小剂量多巴胺或多巴酚丁胺可能对脓毒症患者肝肾等脏器的血液循环有利,可以逆转用去甲肾上腺素升压时对内脏灌流的不良影响。

The data of patients with sepsis or septic shock from Jan 1997 to June 2001 receiving vasoactive agents for more than 4 days were analyzed. APACHE Ⅱ scores and mean arterial blood pressure in these patients before and during vasoactive agents administration were recorded. Patients were assigned to three groups: the group of using high-dose dopamine only, the group of norepinephrine combined with low-dose dopamine or dobutamine, and the group of low-dose dopamine or dobutamine only. The changes in serum creatinine and total hilirubin levels in these patients were analyzed. Results: High-dose dopamine significantly increased serum creatinine and total bilirubin levels(P<0.05). Norepinephrine combined with low-dose dopamine or dobutamine did not make significant changes in the serum creatinine and total bilirubin levels. However, low-dose dopamine or dobutamine markly decreased the serum creatinine level, but not the serum total bilirubin level. Conclusions: Low-dose dopamine or dobutamine might be beneficial for the vital organ circulation such as liver and kidney in septic patients, and might reverse norepinephrine's harmful effects on the splanchnic circulation.