去甲肾上腺素对感染性休克患者血流动力学与肾灌注的影响

Effect of norepinephrine on hemodynamics and renal perfusion in patients with septic shock

目的探讨去甲肾上腺素对感染性休克患者血流动力学与肾灌注的影响。方法选择2015年1月-2017年6月于医院治疗的感染性休克患者160例为研究对象,随机分为多巴胺组与去甲肾上腺素组,各80例。多巴胺组在常规治疗基础上给予多巴胺治疗,去甲肾上腺素组采用去甲肾上腺素治疗。比较两组治疗前及治疗6、12、24、48h的心率、平均动脉压(MAP)、心脏指数(CI)、外周血管阻力指数(SVRI)、混合静脉血氧饱和度(SvO_2),肌酐清除率(Ccr),滤过钠排泄分数(FENa),滤过水排泄分数(FEH_2O),每小时尿量,乳酸清除率。结果治疗后6、12、24、48h去甲肾上腺素组每小时尿量分别为(38.32±5.14)ml/min,(46.92±5.03)ml/min,(57.33±5.61)ml/min,(69.13±6.24)ml/min均高于多巴胺组(P<0.05);治疗后6、12、24、48h去甲肾上腺素组心率分别为(110.50±8.42)次/分,(101.64±7.14)次/分,(94.21±7.12)次/分,(89.33±6.61)次/分均低于多巴胺组(P<0.05);治疗后6、12、24、48h去甲肾上腺素组MAP、SVRI、SvO_2均高于多巴胺组(P<0.05);治疗后6、12、24、48h去甲肾上腺素组FEH_2O(0.27±0.06)%,(0.30±0.08)%,(0.32±0.08)%,(0.31±0.09)%高于多巴胺组(P<0.05),而FENa低于多巴胺组(P<0.05)。两组乳酸清除率治疗后呈上升的趋势,并且治疗6、12、24h去甲肾上腺素组乳酸清除率分别为(33.13±6.61)%,(49.41±8.93)%,(66.13±9.14)%高于多巴胺组(P<0.05)。结论感染性休克选择去甲肾上腺素作为血管活性药物能迅速改善血流动力学,改善肾灌注,较多巴胺效果好。

OBJECTIVE To discuss the effect of norepinephrine on hemodynamics and renal perfusion in patients with septic shock.METHODS 160 cases with septic shock from Jan.2015 to Jun.2017 were selected as subjects,and were divided into the dopamine（DP）group and the norepinephrine（NE）group,with 80 cases in each group.The DP group received dopamine treatment on the basis of conventional treatment,and the NE group received norepinephrine treatment.Heart rate,mean arterial pressure（MAP）,cardiac index（CI）,peripheral vascular resistance index（SVRI）,mixed venous oxygen saturation（SvO2）,creatinine clearance rate（Ccr）,FENa,FEH2O,urine volume per hour and lactate clearance rate before treatment and after 6h,12h,24h,48h of treatment were compared between the two groups.RESULTS Values of urine volume per hour in the NE group after 6h,12h,24h,48h of treatment[（38.32±5.14）ml/min,（46.92±5.03）ml/min,（57.33±5.61）ml/min,（69.13±6.24）ml/min]were significantly higher than those in the DP group（P〈0.05）.HR values in the NE group after 6h,12h,24h,48h of treatment[（110.50±8.42）bpm,（101.64±7.14）bpm,（94.21±7.12）bpm,（89.33±6.61）bpm]were significantly lower than thoset in the DP group（P〈0.05）.MAP,SVRI and（SvO2）in the NE group after 6h,12h,24h,48h of treatment were significantly higher than those in the DP group（P〈0.05）.FEH2O values in the NE group after 6h,12h,24h,48h of treatment[（0.27±0.06）%,（0.30±0.08）%,（0.32±0.08）%,（0.31±0.09）%],were significantly higher than those in the DP group（P〈0.05）.FENa values in the NE group after 6h,12h,24h,48h of treatment[（0.88±0.15）%,（0.84±0.21）%,（0.80±0.23）%,（0.74±0.18）%]were significantly lower than those in the DP group（P〈0.05）.Lactate clearance rates a in the NE group after 6h,12h,24h of treatment[（33.13±6.61）%,（49.41±8.93）%,（66.13±9.14）%]were significantly higher than those in the DP group（P〈0.05）.CONCLUSION Norepinephrine as a vasoactive agent for septic shock can rapidly improve hemodynamics and improve renal perfusion,and has better effects than dopamine.