多巴胺及去甲肾上腺素对脓毒性休克患者微循环的影响

Impact of dopamine and norepinephrine on sublingual microcirculation of the septic shock

目的:研究多巴胺及去甲肾上腺素对老年脓毒性休克患者微循环的影响。方法:将34例脓毒性休克患者随机分为多巴胺组(DA组,n=17)及去甲肾上腺素组(NE组,n=17),在液体复苏的基础上,分别应用多巴胺和去甲肾上腺素使平均动脉压(MAP)稳定至65～75mm Hg并维持1h,然后继续加量多巴胺或去甲肾上腺素,使MAP稳定至75～85mm Hg。应用旁流暗视野技术(Sidestream dark field,SDF)于入组时及MAP在不同水平时测定患者的舌下微血管(≤25μm)的灌注血管密度(PVD)、灌注血管比例(PPV)及微血管流动指数(MFI)。测定血乳酸(Lac)、中心静脉血氧饱和度(ScvO2),观察新发心律失常发生率及28d死亡率。结果:入组时,两组患者的一般资料及PVD、PPV、MFI差异无统计学意义。两组患者的28d死亡率、新发心律失常差异无统计学意义(P>0.05)。两组MAP在65～75mm Hg较入组时,PVD增加有统计学差异(P<0.05),PPV、MFI、Lac、ScvO2差异无统计学意义(P>0.05)。与65～75mm Hg比较,MAP在75～85mm Hg时Lac、ScvO2、PVD、PPV、MFI差异无统计学意义(P>0.05)。结论:多巴胺及去甲肾上腺素均可增加脓毒性休克患者的MAP,在一定程度上改善脓毒性休克微循环障碍,且与剂量增加无明显相关性。

AIM： To investigate the impact of dopamine and norepinephrine on sublingual microcirculation of the septic shock.METHODS： Thirty-four patients with septic shock,were randomly divided into two groups.One group accepted dopamine（the dopamine group,DA）and the other accepted norepinephrine（the norepinephrine group,NE） to maintain mean blood pressure between 65 mm Hg to 75 mm Hg in one hour,and then the medicine dose of both groups was added to maintain mean blood pressure between 75 mm Hg to 85 mm Hg.Sublingual microcirculation was evaluated by sidestream dark field（SDF） imaging before and after the therapy.The 28-day mortality and the number of new arrhythmia was recorded.RESULTS：The 28 days mortality of the DA group and NE group was 47.06% and 52.94%,which had no significant difference（P〈0.05）.The new arrhythmia of the two groups had no significant difference（P〈0.05）.Compared with the base line,PVD after dopamine or norepinephrine therapy was higher both in DA group and NE group（P〈0.05）,but the Lac,ScvO2,PPV,MFI had no difference（P〈0.05）.The Lac,ScvO2,PVD,PPV,MFI of the two different MAP levels had no significant difference in both groups（P〈0.05）.CONCLUSION： Both dopamine and norepinephrine can improve the MAP and the sublingual microcirculatory dysfunction in septic shock,and these impacts do not change with the dose of dopamine and norepinephrine or the level of MAP.