血管升压素及多巴胺对脓毒性休克患者血流动力学和组织氧合的影响

Effects of vasopressin and dopamine on the hemodynamics and tissue oxygenation in the patientswith septic shock

目的探讨血管升压素（特利加压素terlipressin，TP）、多巴胺（dopamine，DA）在治疗脓毒性休克过程中对血流动力学及动脉氧合的影响。方法选择2009-03-2011-05我院EICU收治的脓毒血症患者36例，按随机分原则分别给予TP（TP组）或DA（DA组）升压治疗，分别于治疗0、2、4、和6h检测血流动力学指标[心率（HR）、平均动脉压（MAP）、心排血指数（CI）、每搏指数（SI）、体循环阻力指数（SVRI）、心脏加速指数（ACI）、左室做功指数（LCWI）、胸腔内液体水平（TFC）、心排血量（CO）、中心静脉压（CVP）、肺动脉压（PAP）、肺动脉嵌压（PAWP）等]、中心静脉血氧饱和度（ScvO：）、血乳酸（Lac）及每小时尿量（uV）；于6h末测定肌酐清除率（CCr）。结果两组各时间点MAP、SI及TFC比较差异均无统计学意义；而LCWI治疗2h末比较差异无统计学意义（P=0．031）。DA组的HR、CI及ACI明显高于TP组，而SVRI明显低于TP组（P〈0．05或P〈0．01）；两组给药后各时间点Scv02比较差异无统计学意义（P均〉0．05），而DA组Lac水平明显高于TP组（P均〈0．05），TP组各时间点uV值显著高于DA组（P〈0．05或P〈0．01），TP组给药后6h末SCr值显著高于DA组（P〈0．01）。结论对于伴随快速型心律失常或组织缺氧严重的脓毒性休克患者TP可能是好的选择；TP用于合并急性肾功能不全的脓毒性休克患者，可改善预后，对于伴随少尿（或）肾功能损伤的脓毒性休克患者，在升血压治疗过程中如若产生DA剂量依赖，则选择TP可能更合理。

To explore the effects of vasopressin （terlipressin, TP） and dopamine （DA） on the hemodynamics and tissue oxygenation in the patients with septic shock. Methods 36 septic shock patients were divided randomly into TP group and DA group from March 2009 to May 2011 in EICU. The hemodynamic parameters（HR, MAP, CI, SI, SVRI, ACI, LCWI, TFC, CVP, PAP, PAWP, CO, ScvO2, Lac, UV ） were detected at O, 2, 4, and 6 hours after the treatment. CCr were detected at 6 hour after the treatment. Results MAP, SI and TFC had no difference between two groups at different times. The LCWI had no difference between two groups at 2 h after the treatment （P =0. 031 ）. HR, CI and ACI were significantly higher in the DA group than in the TP group. SVRI were significantly lower in the DA group than in the TP group （ P 〈 0. 05 or P 〈 0. 01 ）. There was no statistical difference in ScvO2 between two groups at different times after the treatment, but Lac level was higher in the DA group than in TP group （ all P 〈 0.05 ）, UV was higher in TP group at the different times than in DA group （ P 〈 0. 05 or P 〈 O. 01 ）, and SCr was higher in TP group at 6 h after the treatment than in DA group （P 〈 0. 01 ）. Conclusion TP may be good choice in the septic shock patients with tachyarrhythmia or severe tissue hyp^xia. TP may improve clinical uteme in the septicshock patients with acute renal dystunction. When septic shock patients with oliguria or renal injure had DA dependence, the TP may be more reasonable choice.