去甲肾上腺素联合多巴酚丁胺对感染性休克患者胃粘膜灌注的作用

目的：观察多巴胺（Dopa)、去甲肾上腺素（NE）、去甲肾上腺素联合多巴酚丁胺（NE＋Dobu）对感染性休克患者胃肠道灌注的影响。方法：符合感染性休克诊断标准的13例患者经过积极的液体复苏后，随机应用血管活性药物，观察胃粘膜内pH(pHi）、胃粘膜与动脉血二氧化碳分压差（△PCO2）的变化。结果：多巴胺、去甲肾上腺素，去甲肾上腺素＋多巴酚丁胺都能提高血压，增加心排指数（CI）、体循环阻力指数（SVRI）、左室每搏功指数（LVSWI）、氧输送（DO2），与基础值比较差异有显著性意义（P＜0．05）；但对胃pHi,△PCO2的改善去甲肾上腺素＋多巴酚丁胺比单独去甲肾上腺素明显，比多巴胺更好，差异有显著性意义（P＜0．05）。结论：多巴酚丁胺和去甲肾上腺素联合即能增加CI、SVRI、LVSWI、DO2，又能改善胃pHi, △PCO2，是治疗感染性休克患者理想的血管活性药。

Effect of norepinephrine combined with dobutamine on gastric mucosal perfusion in patients with septic shock

Objective To observe the respective gastric mucosal perfusion effects of dopamine,norepinephrine,norepinephrine combined with dobutamine in patients with septic shock.Methods After resusctitation by volume expansion,13 patients diganosed with septic shock according to the diagnosis criteria received the various vasoactive drugs randomly.Then changes in gastric intramucosal pH and gastroarterial PCO 2 were observed.Results Dopamine,norepinephrine,norepinephrine combined with dobutamine all had the effects of increasing BP,CI,SVRI,LVSWI and DO 2,with values significantly different from the baseline ( P <0 05).But norepinephrine combined with dobutamine was the strongest in improving gastric intramucnsal pH and gastroarterial PCO 2,with norepinephrine more powerful than dopamine statisticlally( P <0 05).Conclusion Norepinephrine combined with dobutamine,which can not only increase the level of BP,CI,SVRI,LVSWI and DO 2 but also improve gastric intramucosal pH and gastroarterial PCO 2,should be an ideal vasoactive drug to treat septic shock. [