升压药对感染性休克患者血流动力学及生存质量的影响研究

Effect of vasopressor on hemodynamics and quality of life in patients with septic shock

目的：探讨多巴胺（DA ）和去甲肾上腺素（NA）对感染性休克患者血流动力学和生存率的影响。方法采用多中心随机对照研究，选取278例感染性休克患者，分别应用D A和N A进行干预治疗，比较药物应用后不同时点两组患者心率（HR）、平均动脉压（MAP）、心排指数（ CI）、体循环阻力指数（SVRI ）变化和6 h乳酸清除率、28 d生存率。结果治疗6 h后平均早期乳酸清除率DA 组患者为22．3％，明显低于 NA 组患者的59．0％， SVO2≥65％的患者分别占30．9％和64．0％，DA组高乳酸清除和SVO2≥65％的患者均明显少于NA组，差异有统计学意义（P＜0．05）；治疗后各指标值表现出不同的时间效应差异，NA 组1～48 h时 HR均较DA 组低，24～48 h时MAP较DA组高，差异有统计学意义（P＜0．05），两组间CI各时点差异均无统计学意义，NA 组SVRI值在1～48 h时均较DA组高，差异有统计学意义（P＜0．05）；两组患者病死率比较，差异无统计学意义。结论 NA较DA能更好的维持血流动力学稳定，增加脏器灌注，并能有效清除血乳酸，NA在感染性休克中的应用更为安全有效。

OBJECTIVE To investigate the effect on hemodynamics and quality of life in patients with septic shock treated with dopamine （DA） vs. norepinephrine （NA）. METHODS The multicenter randomized controlled study was conducted. Totally 278 patients with septic shock respectively received the intervening treatment with DA and NA, the heart rate （HR）, mean arterial pressure （MAP）, cardiac index （CI）, systemic vascular resistance index （SVRI） at lh（T1）, 4h（T2）, 8h（T3）, 16h（T4）, 24h（T5）, 48h （T6） and lactate clearance rate, creatinine clearance rate at 6h after the drug use, and 28 d survival rate in two groups of patients were compared. RESULTS The average lactate clearance rate at 6hafter treatment was 22. 3% in DA group, significant lower than 59. 0% in NA group. There were 30. 9% and 64. 0% of patients who had SVO2 ≥ 65% in DA and NA groups. The number of patients with the average lactate clearance rate and SVO2 ≥ 65% in DA group was significantly lower than those in the NA group （P〈0. 05）. Each indicator showed different time effects after treatment as HR in NA group was lower than that in DA group at 1 - 48h and MAP in NA group was higher than in DA group at 24-48h, with statistical significance （P〈0. 05）. There were no statistically significant differences in CI between the two groups at each time point. SVRI was significantly higher in the NA group than in the DA group at 1-48h（P〈0. 05）. There were no significant differences in mortality between the two groups. CONCLUSION NA can maintain hemodynamic stability, increase organ perfusion, and can effectively remove blood lactate than DA, NA is a safe and effective medicine in septic shock.