血管活性药物对感染性休克患者肾脏灌注的影响

Effect of Vasoactive Drugs on Renal Perfusion in Patients With Septic Shock

目的:观察血管活性药物多巴胺、多巴胺加间羟胺、去氧肾上腺素加多巴酚丁胺对感染性休克患者肾脏灌注的影响。方法:63例感染性休克患者经过积极的液体复苏以后,随机分成3组,分别应用多巴胺、多巴胺加间羟胺、去氧肾上腺素加多巴酚丁胺,观察尿量、肌酐清除率(Ccr)、钠排泄分数(FeNa)的变化。结果:多巴胺组和去氧肾上腺素加多巴酚丁胺组尿量明显多于基础值时(P<0.05);Ccr去氧肾上腺素加多巴酚丁胺组明显高于基础值时和其他各组(P<0.05);FeNa去氧肾上腺素加多巴酚丁胺组明显低于基础值时和其他各组(P<0.05),多巴胺组与基础值时比较,显著增高(P<0.05)。结论:使用去氧肾上腺素加多巴酚丁胺能改善肾脏灌注,显著增加Ccr;多巴胺能增加尿量和FeNa,但改善肾脏灌注作用不确切;多巴胺加间羟胺不能改善肾灌注。

Objective： To observe the effect of vaso-active drugs （dopamine, dopamine plus metaraminol, phenylephrine plus dobutamine） on renal perfusion in patients with septic shock. Methods： Sixty-three patients with septic shock after volume resuscitation were divided randomly into three groups. Changes of urine output, creatinine clearance （Ccr） and fractional excretion of sodium （FeNa） were observed. Results： Urine output in both dopamine group and phenylephrine plus dobutamine group were much more increased than baseline value（P〈0. 05） ; Ccr in phenylephrine plus dohutamine group was significantly higher than that in baseline group and other groups（P〈 0. 05） ; FeNa in phenylephrine plus dobutamine group was obviously lower than that in baseline and other groups（P 〈0. 05） ; but FeNa in dopamine group was much higher than baseline （P〈0. 05）. Conclusions： Treatment with phenylephrine plus dobutamine could significantly improve renal perfusion and increase Ccr. Dopamine could markedly elevate urine output and FeNa, but the role of improving renal perfusion was not definit. Dopamine plus metaraminol can not improve renal perfusion.