多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏器官灌注的影响

目的 :观察多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏灌注的影响。方法 :静脉注射内毒素 (L PS)复制绵羊感染性休克模型 ,当收缩压下降至低于 90 .0 0 m m Hg(1m m Hg=0 .133k Pa)或较L PS注射前降低 39.75 m m Hg时记录血流动力学及肠黏膜 p H(p Hi)的基础值。 2 0只绵羊随机分为两组 ,分别静脉注射多巴酚丁胺加去甲肾上腺素和多巴胺 ,调整药物剂量 ,使平均动脉压升高到 90 .0 0 mm Hg,观察药物使用前 (基础值 )及用药后 1、2、3、4 h的血流动力学和内脏灌注指标 p Hi。结果 :在 L PS注射前和基础状态 ,多巴胺组与多巴酚丁胺 +去甲肾上腺素组的血流动力学、氧代谢和肠道 p Hi指标均无明显差异 ;与基础值相比 ,两组动物在用药后血压、心脏指数及氧输送明显升高。多巴胺组用药 4 h动脉乳酸浓度及 p Hi水平与基础值比较无明显改变 ;但动脉 p H值基础水平为 7.4 0± 0 .0 5 ,多巴胺应用 1h后显著降低至 7.2 6± 0 .0 6 (P<0 .0 5 )。应用多巴酚丁胺加去甲肾上腺素后 3和 4 h,动脉乳酸浓度分别为 (2 .3± 1.1) m mol/ L 和 (2 .1± 1.1) m mol/ L,均显著低于基础水平 (4 .0± 1.8) m mol/ L(P<0 .0 5 )。应用多巴酚丁胺加去甲肾上腺素前动物 p Hi为 7.19±0 .0 4 ,用药后 3h,p Hi明显升高到

Comparison of effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock

OBJECTIVE: To compare the effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock. METHODS: Twenty sheep with septic shock induced by lipopolysaccharides were divided into two groups. When systolic pressure was decreased to 39.75 mm Hg(1 mm Hg=0.133 kPa), basic values of hemodynamic parameters and intestinal intramucosal pH (pHi) were monitored. The animals were randomized to either receive an intravenous infusion of norepinephrine-dobutamine in combination or dopamine alone, and the dosage was titrated to obtain a mean arterial pressure (MAP)> 90.00 mm Hg with an optimal cardiac preload. Hemodynamic parameters and mucosal pHi were repeatedly measured at 1-, 2-, 3-, 4-hour after basic measurement. RESULTS: After norepinephrine-dobutamine or dopamine infusion, MAP, cardiac output, and oxygen delivery were increased in all animals compared to basic values in both groups (P<0.05). Compared to baseline values (4.0+/-1.8)mmol/L, lactate concentrations were decreased at 3-hour (2.3+/-1.1) mmol/L and 4-hour (2.1+/-1.1)mmol/L in the norepinephrine-dobutamine group (P<0.05). There were no differences in arterial lactate concentrations in the dopamine group, but arterial pH was decreased from 7.40+/-0.05 to 7.26+/-0.06 at 2-hour (P<0.05 ). No Change in pHi was found in the dopamine group, but in the norepinephrine-dobutamine group, compared to baseline, pHi was increased from 7.19+/-0.04 to 7.36+/-0.07 at 3-hour (P<0.05). CONCLUSION: Both norepinephrine-dobutamine and dopamine could improve systemic hemodynamics in sheep with septic shock, but the effect of norepinephrine-dobutamine in combination was better than dopamine on splanchnic perfusion.