不同剂量去甲肾上腺素对感染性休克患者血流动力学和不良反应的影响

Effects of different doses of norepinephrine on hemodynamics and adverse reactions in patients with septic shock

目的探讨不同剂量去甲肾上腺素对感染性休克患者血流动力学和不良反应的影响。方法选取2018年4月至2021年3月于金华市人民医院接受治疗的感染性休克患者98例,采用随机数字表法将其分为观察组(n=49)和对照组(n=49)。两组患者均采用液体复苏,待中心静脉压(central venous pressure,CVP)达到15mmHg,静脉滴注重酒石酸去甲肾上腺素注射液。对照组患者起始剂量为1μg/min,最大注射量≤25μg/min,维持剂量2μg/min;观察组患者起始剂量2μg/min,最大注射量≤50μg/min,维持剂量4μg/min。治疗6h后,比较两组患者的心率(heart rate,HR)、心脏指数(cardiac index,CI)、平均动脉压(mean artery pressure,MAP)、CVP、血尿素氮(blood urea nitrogen,BUN)和血肌酐(creatinine,Cr)水平,并记录两组患者48h内不良反应发生情况。结果治疗6h后,观察组患者的HR显著低于对照组(P<0.05),CI、MAP、CVP、BUN、Cr均显著高于对照组(P<0.05);治疗48h后,观察组患者的总并发症发生率显著高于对照组(40.82%vs 10.20%,χ^(2)=14.232,P<0.05)。结论大剂量去甲肾上腺素可改善感染性休克患者的血流动力学指标,但对肾功能有一定损害,并增加不良反应发生率。

Objective To investigate the effects of different doses of norepinephrine on hemodynamics and adverse reactions in patients with septic shock.Methods A total of 98 patients with septic shock treated in Jinhua People's Hospital from April 2018 to March 2021 were selected and divided into observation group(n=49)and control group(n=49)by random number table method.The patients in both groups were resuscitated with fluid,and when the central venous pressure(CVP)reached 15mmHg,intravenous norepinephrine tartrate injection was emphasized.In control group,the initial dose was 1μg/min,the maximum injection volume was≤25μg/min,and the maintenance dose was 2μg/min.In observation group,the initial dose was 2μg/min,the maximum injection volume was≤50μg/min,and the maintenance dose was 4μg/min.After 6 hours of treatment,heart rate(HR),cardiac index(CI),mean artery pressure(MAP),CVP,blood urea nitrogen(BUN)and creatinine(Cr)were compared between the two groups,and the occurrence of adverse reactions in the two groups within 48 hours was recorded.Results After 6 hours of treatment,HR of observation group was significantly lower than that of control group(P<0.05),and CI,MAP,CVP,BUN and Cr were significantly higher than those of control group(P<0.05).After 48 hours of treatment,the total complication rate of observation group was significantly higher than that of control group(40.82%vs 10.20%,χ^(2)=14.232,P<0.05).Conclusion High dose norepinephrine can improve the hemodynamic indexes of patients with septic shock,but has some damage to renal function and increase the incidence of adverse reactions.