不同血管活性药对脓毒性休克患者血流动力学和乳酸清除率的作用

Effect of Different Vasoactive Drug on Hemodynamic Parameters and Lactate Clearance Rate of Patients with Septic Shock

目的比较应用多巴胺与去甲肾上腺素联用多巴酚丁胺对脓毒性休克（SS）患者血流动力学和乳酸清除率（LCR）的影响。方法35例SS患者经过充足的液体复苏使肺动脉楔压维持在12～15mmHg,随机分A组（17例）和B组（18例）。测定并计算A、B组治疗前、治疗后6、12、24h各个时间点的血流动力学指标包括外周血管阻力指数、心脏指数、平均动脉压和LCR。结果用药后两组同一时间点,B组12、24h的平均动脉压（〉80.5mmHg为达标）、外周血管阻力指数、心脏指数明显高于A组（P〈0.05）,A组的24h乳酸清除率比B组水平高（P〈0.01）,两组差异有统计学意义。结论去甲肾上腺素加多巴酚丁胺治疗SS能更好地维持血流动力学稳定和提升血压,提高LCR。

Objective To compare the effect of norepinephrine dobutamine in combination and that of dopamine alone on the Hemodynamic parameters and lactate clearance in patients with septic shock （SS）. Methods Totally 35 cases with SS underwent the sufficiently fluid resuscitation and the pulmonary arterial wedge pressure was kept between12 ~ 15 mmHg. The cases were randomly divided into groupA （ n = 17 ）, which treated with dopamine, and groupB （n = 18 ）, which treated with norepinephrine and dobutamine. The mean arterial pressure was kept more than 80.5 mm Hg. A series of indexes including systemic vascular resistance index, cardiac index, mean arterial pressure, lactate clearance rate ,were detected before pretherapy, and 6 h, 12 h ,24 h after treatment. Results After norepinephrine dobutamine or dopamine infusion, com- pared to group A, systemic vascular resistance index, cardiac index, mean arterial pressure were higher significantly at the same time of 12 h,24 h （P 〈0.05） ,lactate clearance rate were higher significantly in group B at the same time of 24 h （ P 〈 0.05 ）. Conclusion It suggested that combination of norepinephrine and dobutamine had better effect on maintaining the stable of hemodynamics in SS,and also raise blood pressure, increase lactate clearance.