多巴胺及去甲肾上腺素对感染性休克患者血流动力学和组织氧代谢的影响

目的探讨多巴胺(DA)及去甲肾上腺素(NE)在治疗感染性休克过程中对血流动力学和组织氧代谢的影响。方法选择我科腹部外科术后感染性休克患者46例,按随机原则分别给予DA(DA组)或NE(NE组)升压治疗。分别观察入组时、入组后1~6h的血流动力学指标[心率(HR)、平均动脉压(MAP)、心排出量指数(CI)、每搏指数(SI)、体循环阻力指数(SVRI)]、混合静脉血氧饱和度(SvO2)、早期乳酸清除率、28d死亡率;每小时尿量(UV)和12h后肌酐清除率(Ccr)。结果①两组各时间点MAP、CI、SVRI比较差异均无统计学意义,DA组的HR明显高于NE组,而SI低于NE组(P0.05)。②3h后NE组SvO2值较DA组明显增高(P0.05),6h后NE组SvO2≥65%的比例也明显高于DA组;NE组早期乳酸清除率明显高于较DA组[(24.8±15.7)%vs(16.2±14.2)%,P=0.003],NE组高的早期乳酸清除率比例明显高于较DA组,③两组6h后UV以及12h末的Ccr水平无明显差异。④两组之间28d死亡率无统计学差异。结论NE在内脏灌注和组织氧代谢方面优于DA。对于腹部外科术后感染性休克患者,NE可能是更好的选择。

Effect of dopamine and norepinephrine on hemodynamics and oxygen metabolism of tissue in patients with septic shock

Objective To evaluate the effects of dopamine （DA） and norepinephrine （NE） on hemodynamics and oxygen metabolism of tissue in patients with septic shock. Methods Forty sixty patients with septic shock after abdominal surgery were assigned to the groups of DA and NE randomly. They were given DA or NE for 6 hours. Heart rate （HR）, mean artery pressure （MAP）, cardiac index （CI）, stroke index （SI）, systemic vascular resistance index （SVRI）, mixed venous oxygen saturation （SvO2）, early lactate clearance, and urine volume per hour （UV） were measured at the end of the 6 hour after the treatment. Creatinine clearance rate （Ccr） was measured at the end of the 12th hour after treatment. Results There were no differences in MAP, CI or SVI between the two groups, HR was higher while SI was lower in DA group than that in NE group （P〈0.05）. SvO2 and early lactate clearance in the group of NE were significantly higher than those in the group of DA （P〈0.05）. There was no significant difference in UV, Ccr or 28-day mortality between two groups. Conclusions NE has better effects than DA on improving internal organ perfusion and tissue oxygenation. NE may be a better choice for the patients with septic shock after abdominal surgery.