多巴酚丁胺对老年感染性休克患者灌注水平及氧代谢改善的影响

目的：研究老年感染性休克患者应用多巴酚丁胺后的灌注水平及氧代谢状况。方法选取2014年3月至2015年12月我院急诊科接诊的40例ICU老年感染性休克患者进行研究。所有患者均应用多巴酚丁胺进行治疗。治疗前和治疗6 h、24 h后观察并记录患者的HR (心率)、平均动脉压(MAP)、心排出量(CO)、心排血指数(CI)，氧输送(DO2)、中心静脉血氧饱和度(ScvO2)、乳酸(Lac)及Lac清除率。结果治疗前患者的HR为(112±17)次/min，治疗6 h和24 h后分别为(101±16)次/min和(94±10)次/min，与治疗前比较均明显降低，差异有统计学意义(P<0.05)；治疗24 h后与治疗前比较，MAP、CO、CI水平均明显升高(68±11) mmHg、(4.3±0.2) L/min、(2.4±0.4) L/(min·m2)] vs (86±10) mmHg、(6.0±0.3) L/min、(4.1±0.3) L/(min·m2)]，差异有统计学意义(P<0.05)。治疗6 h和24 h后，患者的DO2水平分别为(0.96±0.11) L/min、(1.21±0.58) L/min，与治疗前的(0.80±0.06) L/min比较差异均有统计学意义(P<0.05)；治疗24 h后的ScvO2为(77±6)%，与治疗前的(49±5)%比较明显升高，差异有统计学意义(P<0.05)；治疗24 h后Lac为(2.67±0.57) mmol/L，较治疗前的(5.81±1.98) mmol/L明显降低，差异有统计学意义(P<0.05)；治疗24 h后Lac清除率为(56.43±2.65)%，明显高于治疗6 h后的(36.31±2.21)%，差异有统计学意义(P<0.05)。结论多巴酚丁胺治疗老年感染性休克可显著改善患者的灌注水平及氧代谢状况，值得临床推荐使用。

Effects of dobutamine on the improvement of perfusion levels and oxygen metabolism in the elderly patients with septic shock

Objective To investigate the effects of dobutamine on the improvement of perfusion levels and ox-ygen metabolism in the elderly patients with septic shock. Methods A total of 40 cases of the elderly patients with sep-tic shock, who admitted to ICU of our hospital and underwent fluid resuscitation treatment with dobutamine from March 2014 to December 2015, were selected as research objects. The heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), cardiac output index (CI), oxygen delivery (DO2), central venous oxygen saturation (ScvO2), lactic acid (Lac) and Lac clearance of before treatment, and 6 h and 24 h after treatment were recorded. Results The HR of pa-tients of preoperative (112 ± 17) times/min] was significantly higher than postoperative 6 h (101 ± 16) times/min] and 24 h (94±10) times/min] (P<0.05). The MAP, CO, CI levels of postoperative 24 h (68±11) mmHg, (4.3±0.2) L/min, (2.4 ± 0.4) L/(min·m2), respectively] were significantly higher than preoperative (86 ± 10) mmHg, (6.0 ± 0.3) L/min, (4.1±0.3) L/(min·m2), respectively] (P<0.05). The DO2 of postoperative 6 h (0.96±0.11) L/min and 24 h (1.21±0.58) L/min] were significantly higher than preoperative (0.80 ± 0.06) L/min] (P<0.05). The ScvO2 of postoperative 24 h (77 ± 6)%] was significantly higher than preoperative (49 ± 5)%] (P<0.05). The Lac of postoperative 24 h (2.67 ± 0.57) mmol/L] was significantly lower than preoperative (5.81 ± 1.98) mmol/L] (P<0.05). The Lac clearance rate of postoperative 24 h (56.43 ± 2.65)%] was significantly higher than postoperative 6 h (36.31 ± 2.21)%] (P<0.05). Conclusion The dobuta-mine treatment for the elderly patients with septic shock can significantly improve the patient's perfusion levels and oxy-gen metabolism, which is worthy of clinical application.