多巴胺对急性重症胰腺炎合并感染性休克患者肾功能的影响

Effect of dopamine on renal function in the patients with acute severe pancreatitis complicated with septic shock

目的：研究多巴胺对急性重症胰腺炎合并感染性休克患者肾脏功能的影响．方法：选择1998年以来在我院接受治疗的急性重症胰腺炎合并感染性休克患者39例，按照患者多巴胺最大泵注速率的不同分为A组14例，B组14例，C组11例，3组患者多巴胺最大泵注速率依次为2—9μg／（kg·min），10～15μg/（kg·min），〉15μg/（kg·min）．测定、记录所有患者MAP，HR，尿量，BUN，CRE，U-ALB和Uβ2-MG定量及APACHEⅢ评分．结果：治疗前，3组患者均表现有低血压、心动过速和少尿，多数患者CRE，BUN，U—ALB，Uβ2-MG和APACHEⅢ评分高于正常值上限．经过抗休克治疗，所有患者的MAP，HR，尿量及BUN，CRE均恢复到正常范围（P〈0．01），U—ALB，Uβ2-MG定量及APACHEⅢ评分也有所恢复（P〈0．01），但仍高于正常．结论：在急性重症胰腺炎合并感染性休克的治疗中，应以恢复脏器血流灌注为首要目标，以容量复苏为主，必要时辅以多巴胺等血管活性药物来维持循环稳定．

AIM： To study the effect of dopamine on the renal function in the patients with acute severe panereatitis complicated with septic shock. METHODS： Thirty-nine patients with acute severe panereatitis complicated with septic shock were divided into 3 groups according to the maximal infusing rate of dopamine used ： group A, n=14, 2-9μg/（kg ·min）; group B, n=14, 10- 15 μg/（kg· min） ; and group C, n = 11, 〉 15 μg/（kg ·min）. Mean arterial blood pressure（MAP） , heart rate（HR） , urine output, blood urea nitrogen （ BUN ） , creatinine （CRE） , urine albumin（U-ALB） and urine β2-microglubulin （Uβ2-MG） as well as APACHE Ⅲ scores were detected and recorded for all the patients. RESULTS： Before anti-shock therapy, hypotension, tachycardia and oliguria occurred to all 39 patients with acute severe panereatitis complicated with septic shock, and CRE, BUN, U-ALB, Uβ2-MG and APACHE Ⅲ scores were above the normal in most cases. After anti-shock therapy, MAP, HR, urine output and BUN, CRE in all patients from the 3 groups gradually returned to their normal levels （ P 〈 0.05 vs those before anti-shock therapy）, and U-ALB, UI32-MG output and APACHE Ⅲ scores also restored but still remained in their abnortnal levels （P 〈0.01 vs those before anti-shock therapy）. CONCLUSION： The first goal to treat the patients with acute severe pancreatitis complicated with septic shock should be the restoration of the organ blood supply, and based on volume resuscitation. Dopamine and other vasoactive drugs could be adjunctively used to maintain circulatory stability.