不同血管活性药物对脓毒性休克患者心率及肾功能的影 响简

目的：探讨不同血管活性药物对脓毒性休克患者心率及肾功能的影响。方法选取经过充分液体复苏后仍存在低血压的脓毒性休克患者78例，随机分为两组，多巴胺组给予多巴胺针5～30μg＆#183;kg-1＆#183;min-1泵入；去甲肾上腺素组给予去甲肾上腺素针0.5～3μg＆#183;kg-1＆#183;min-1泵入维持血压。比较用药后两组患者血压、心率及肾功能变化。结果多巴胺组和去甲肾上腺组患者平均动脉压在T0.5、T1、T3、T6时点与T0比较均明显上升（t分别=3.24、2.37、3.23、6.97；2.34、2.12、4.99、4.81，P均＜0.05），但同一时间点两组之间差异无统计学意义（t分别=1.15、1.32、1.66、1.39， P＞0.05）。多巴胺组和去甲肾上腺组患者心率在T0.5、T1、T3、T6时点与T0比较，差异均有统计学意义（t分别=2.80、5.71、3.75、9.71；8.43、3.45、2.41、2.11，P均＜0.05），两组各时间点心率组间比较，差异亦均有统计学意义（t分别=2.32、2.11、4.06、2.65，P均＜0.05）。两组用药后各时点血肌酐、肌酐清除率组内及组间比较，差异均无统计学意义（F分别=2.01、2.33；1.98、2.05；t分别=1.65、1.15、1.21、0.98；1.89、1.34、1.71、0.85，P均＞0.05）。结论两种药物均能提高脓毒性休克患者的血压，但多巴胺针组心率增快更明显。两组对肾功能的影响无明显差异。

Effect of different vascular active drug on heart rate and renal function in patients with septic shock

Objective To explore the effect of different vascular active drug on heart rate and renal function in patients with septic shock. Methods A total of 78 patients with septic shock who remains low blood pressure after sufficient liquid recovery were select and randomly divided into dopamine group which was given dopamine needle 5~20μg＆#183;kg-1＆#183;min-1 and norepinephrine group which was given norepinephrine needle 0.5~2 μg＆#183;kg-1＆#183;min-1. The mean arterial pressure, heart rate and renal function were compared. Results The mean arterial pressure of both group were significantly increased when camparing T0.5, T1, T3, T6 with T0 （t=3.24, 2.37, 3.23, 6.97, 2.34, 2.12, 4.99, 4.81, P〈0.05）. But the difference of both two group were not statistically significant at the same point （t=1.15, 1.32, 1.66, 1.39, P＆gt;0.05）. The heart rate of both group were significantly different when comparing T0.5, T1, T3, T6 with T0 （t=2.80, 5.71, 3.75, 9.71, 8.43, 3.45, 2.41, 2.11, P〈0.05）. Comparing heart rate on the same time point , the difference of both group were statistically signifi-cant at the same point （t=2.32, 2.11, 4.06, 2.65, P〈0.05）. The serum creatinine and creatinine clearance rate of both groups were without statistical significant difference as well as at the same point（F=2.01, 2.33, 1.98, 2.05;t=1.65, 1.15, 1.21, 0.98, 1.89, 1.34, 1.71, 0.85, P〉0.05）. Conclusion Dopamine and norepinephrine can improve blood pressure in patients with septic shock, but dopamine can speed up the heart rate obviously. There was no difference between the influence of two drugs on renal function.