多巴胺与去甲肾上腺素在感染性休克中的应用研究

The research on application of dopamine and norepinephrine in sepsis shock

目的探讨多巴胺(DA)及去甲肾上腺素(NE)在感染性休克治疗过程中对血流动力学和组织氧代谢的影响。方法选择感染性休克患者52例,随机分为DA组与NE组各26例,分别予DA及NE进行升压治疗。观察入组时、入组后3h、6h的血流动力学指标[心率(HR)、平均动脉压(MAP)、中心静脉压(CVP)、心排指数(CI)、体循环阻力指数(SVRI)],组织氧利用及代谢指标[混合静脉血氧饱和度(SvO2)、早期乳酸清除率、尿量(UV)和内生肌肝清除率(Ccr)]。结果 2组各时间点MAP、CVP、CI、SVRI比较差异无统计学意义(P>0.05),DA组的HR明显高于NE组(P<0.05)。NE组与DA组在补液并给药后SvO2均有上升,6h后NE组SvO2≥65%的比例高于DA组(P<0.05);6h后NE组早期乳酸清除率明显高于DA组(P<0.05),NE组高的早期乳酸清除率比例明显高于DA组。2组6h后UV以及Ccr水平无明显差异(P>0.05)。结论在感染性休克时,补液是必须的,早期应用血管活性药物NE在改善内脏灌注方面和组织氧合方面优于DA,并能减慢心率,在肾功能保护方面也可能优于DA。对于感染性休克患者,NE可能是更好的选择。

Objective To evaluate the effects of dopamine（DA）and norepinephrine（NE）on hemodynamics and oxygen metabolism of tissue in patients with septic shock. Methods 52 cases of patients with septic shock were assigned to the groups of DA and NE randomly,each of 26 cases. They were given DA or NE for treatment. mean the heart rate（HR）,ar-tery pressure（mAP）,central venous pressure（CVP）,ardiac index（CI）,systemic vascular resistance index（SVRI）,mixed venous oxygen saturation（SvO2 ）were measured at begin,the 3 hour and the end of the 6 hour after treatment. Early lactate clearance,urine volume（UV）and creatinine clearance rate（Ccr）was measured at the end of the sixth hour after treatment. Results There were no significant differences in mAP,CVP,CI and SVRI between the two groups（P ﹥ 0. 05）;the HR was higher in DA group than that in NE group（P ﹤ 0. 05）. After fluid infusion and drug delivery,the SvO2 of NE group and DA group was both increased,but the rate of SvO2≥65% in NE group was higher than that of the DA group after 6 hours（P ﹤0. 05）,and early lactate clearance in the group of NE were significantly higher than those in the group of DA（P ﹤ 0. 05）. There was no significant difference in UV,Ccr between2 groups（P ﹥ 0. 05）. Conclusion In septic shock,fluid replacement is necessary,we should use the vasoactive drugs early. NE has better effects than DA on improving internal organ perfusion and tissue oxygenation,which may be a better choice for the patients with septic shock.