去甲肾上腺素与多巴胺对低血容量休克患者血压稳定性及血流动力学的比较

目的 比较去甲肾上腺素(NE)与多巴胺(DA)治疗低血容量休克患者的安全性,以及对血压稳定性和血流动力学影响。 方法 82例低血容量休克患者在液体复苏的基础上,分别给予去甲肾上腺素(NE组,41例)和多巴胺(DA组,41例)。比较血压恢复情况,血流动力学指标的变化,记录两组并发症及病死率。 结果 两组血压均于用药后15min时基本恢复正常,30min后血压平稳。除了15min时,DA组的收缩压高于NE组,其余时点两组收缩压和舒张压差异均无统计学意义(P>0.05)。T₀时点比较,两组T₁、T₂、T₃时间点的CVP、CI、ELWI、ITBI明显升高(P<0.05)。DA组除了T₂时点ELWI较NE组显著升高,其余各时间点比较,差异均无统计学意义(P>0.05);治疗后24h,两组血氧饱和度、尿量均明显上升,血乳酸明显下降,而NE组乳酸明显低于DA组(P<0.05);NE组心律失常的发生率、2周内病死率均较DA组显著下降(P<0.05);两组急性肾损伤的发生率比较,差异无统计学意义(P>0.05)。 结论 NE在维持低血容量性休克患者血压及血流动力学稳定方面与DA是等效的,且未增加急性肾损伤的风险,但NE可有效改善组织灌注、减少心律失常及病死率,改善临床转归。

Comparison of Dopamine and Norepinephrine in the Stability of Blood Pressure and Haemodynamics in Hypovolemic Shock

Objective To compare the safety of dopamine(DA) and norepinephrine(NE) in hypovolemic shock, and the impact on the stability of blood pressure and haemodynamics. Methods Eighty two patients with hypovolemic shock were given fluid resuscitation. All the patients were divided into two groups including DA group(n=41) and NE group(n=41). Recovery of blood pressure, hemodynamic parameters were observed at different time point, and the complications and mortality of two groups were recorded. Results Blood pressure of all the patients returned to normal in 15min after the medication, and became stable after 30min. There was no significant difference in the blood pressure in both groups except that of 15min. Compared with T0, There were higher in the numerous of CVP, CI, ELWI, ITBI. The ELWL at T2 in DA group was higher than that of NE group, while there was no significant difference in the other time points between the two groups(P>0.05). After treatment for 24 h, blood oxygen saturation, urine volume in two groups were significantly increased, blood lactic acid markedly reduced, but lactic acid in NE group was obviously lower than that in DA group(P<0.05). Compared with DA group, the incidence of arrhythmia cordis, 2-week mortality in NE group were significantly reduced (P<0.05), while the acute kidney injury in two group was not statistically different (P>0.05). Conclusion The effect of NE and DA in maintaining the stability of blood pressure and hemodynamic are equivalent, and NE did not increase the risk of acute kidney injury, but can effectively improve tissue perfusion, reduce arrhythmia and case fatality rate, improve clinical outcomes.