去甲肾上腺素联合多巴酚丁胺对感染性休克患者早期血乳酸及肾灌注的影响

Influence of norepinephrine combined with dobutamine on early blood lactate and renal perfusion of patients with infectious shock

目的探讨去甲肾上腺素联合多巴酚丁胺对感染性休克患者早期血乳酸及肾灌注的影响。方法 72例感染性休克患者分为观察组36例和对照组36例。观察组泵入甲肾上腺素(NE),对照组泵入多巴胺(DA),2组患者均联合使用多巴酚丁胺。对2组患者在治疗前,治疗后5、10 h,1、2 d的血乳酸水平、HR、血清肌酐、尿量、血钠进行检测。结果治疗后,2组患者的血乳酸水平、HR、FENa与治疗前相比均明显下降,且观察组患者治疗后的血乳酸水平、HR、FENa显著优于对照组(P<0.05)。治疗后,2组患者的UV、FFH2O与治疗前相比均明显增加,且观察组患者治疗后的UV、FFH2O显著高于对照组(P<0.05)。2组患者治疗前后的CCr无显著变化(P>0.05),但2组治疗后的CCr较治疗前均有明显增加。结论去甲肾上腺素联合多巴酚丁胺能降低感染性休克患者的早期血乳酸水平,改善肾灌注,值得推广使用。

Objective To explore the influence of norepinephrine combined with dobutamine on early blood lactate and renal perfusion of patients with infectious shock. Methods A total of 72 patients with infectious shock were divided into observation group（ n = 36） and control group（ n =36）. The observation group was pumped with norepinephrine（ NE）,the control group was pumped with dopamine（ DA）,and both groups were treated with dobutamine. Blood lactate level,continuous ECG monitoring rate（ HR）,serum creatinine,urine and serum sodium were detected at the time points of before treatment,5 hours and 10 hours after treatment as well as 1 day and 2 days after treatment. Results After treatment,blood lactate level,HR and FENa decreased significantly in both group,and the levels of these indexes in the observation group were significantly better than those in the control group（ P〈0. 05）. After treatment,UV and FFH2 O in both group increased significantly,and levels of UV and FFH2 O in the observation group were significantly higher than those in the control group（ P〈0. 05）. There was no significant change of CCr before and after treatment between two groups（ P〉0. 05）,but the CCr level increased significantly in both groups when compared with the level before treatment. Conclusion Norepinephrine combined with dobutamine can decrease the early blood lactate of patients with infectious shock and improve renal perfusion,so it is worthy of application.