多巴胺联合去甲肾上腺素对感染性休克患者肾脏功能的影响

目的研究多巴胺与去甲肾上腺素联合应用对感染性休克患者肾脏功能的影响。方法选择1996年以来在我科ICU接受治疗的感染性休克患者87例,以去甲肾上腺素最大泵注速率分为3组:其中A组28例(0．5～0．9μg·kg-1·min-1),B组30例(1．0～1．5μg·kg-1·min-1), C组29例(1．6～2．0μg·kg-1·min-1)。测定记录所有患者的平均静脉压(MAP)、心率(HR)、尿量、血尿素氮(BUN)、肌酐(CRE)、尿白蛋白(U-ALB)和β2微球蛋白(Uβ2-MG)定量及APACHEⅢ评分。结果治疗前,3组患者均有低血压、心动过速和少尿,多数患者CRE、BUN、U-ALB、Uβ2-MG和APACHEⅢ评分高于正常值上限。经过抗休克治疗,所有患者的MAP、HR、尿量及BUN、CRE均恢复到正常范围,U-ALB、Uβ2-MG定量及APACHEⅢ评分也有所恢复,但仍高于正常。结论在感染性休克的治疗中,应以恢复脏器血流灌注为首要目标,以容量复苏为主,必要时辅以多巴胺、去甲肾上腺素等血管活性药物来维持循环稳定。

Effect of dopamine combined with norepinephrine on the renal function in patients with septic shock

OBJECTIVE: To investigate the effects of dopamine and norepinephrine on the renal function in the patients with septic shock. METHODS: Eighty-seven patients with septic shock were divided into three groups (group A, B, C) according to the biggest infusing rate of norepinephrine, with the infusing rate of 0.5 - 0.9, 1.0 - 1.5, 1.6 - 2.0 microg x kg(-1) x min(-1), respectively. Mean arterial blood pressure (MAP), heart rate (HR), urine output, blood urea nitrogen (BUN), creatinine (CRE), urine albumin (U-ALB) and urine beta(2)-microglobulin (Ubeta(2)-MG) as well as APACHE III score in all the patients were detected. RESULTS: Before anti-shock therapy was given, hypotension, tachycardia and oliguria occurred in all the 87 patients, and CRE, BUN, U-ALB, Ubeta(2)-MG and APACHE III score were abnormal in most cases. With the anti-shock therapy, MAP, HR, urine output and BUN, CRE in all patients returned to normal levels gradually, and U-ALB, Ubeta(2)-MG levels and APACHE III score also restored but still remained abnormal. CONCLUSIONS: The first aim of treating septic shock should be restoring the organ blood supply, and based on volume resuscitation, dopamine, noradrenaline and other vasoactive drugs could be combined to maintain circulatory stability.