多巴胺和去甲肾上腺素对感染性休克患者肾灌注的影响

目的 研究多巴胺与去甲肾上腺素对感染性休克患者肾灌注的影响.方法 选择ICU早期感染性休克患者44例为研究对象,随机分成多巴胺组(Dopa组)和去甲肾上腺素组(NE组).分别测定并计算应用多巴胺或去甲肾上腺素前(0o)及用药后1 h(T1)、4 h(T2)、8 h(T3)、16 h(T4)、24 h(T5)、48 h(T6)各个时间点的血流动力学指标,测定记录所有患者尿量(UF)、血清肌酐(CCr)、滤过钠排泄分数(FENa)和滤过水排泄分数(FEH2O).结果 与EN组比较Dopa组UF显著增加(P＜0.05),CCr 2组比较差异无统计学意义(P＞0.05);治疗后NE组FEH2O增加(P＜0.05),而Dopa组无明显变化.与Dopa组同一时间点相比NE组的FEH2O明显增加(P＜0.01);治疗后NE组在T4后FENa减少,Dopa组治疗前后无明显变化.T4后和Dopa组同一时间点相比NE组的FENa显著减少(P＜0.05).结论 多巴胺和去甲肾上腺素均能改善感染性休克患者血压、改善肾灌注.去甲肾上腺素对感染性休克合并心动过速及严重组织缺氧的患者是一个比较好的选择.

Effects of dopamine and norepinephrine on renal perfusionin patientswith septic shock

Objective To compare the effect of dopamine(Dopa) and norepinephrine(NE) to reverse renal perfusion in patients with septic shock.Methods 44 patients with septic shock were divided into two groups of Dopa group and NE group randomly.Serial measurements of urine flow(UF),CCr,FENa,FEH2O were made before infusion(T0),after infusion at 1-hour(T1),4-hours(T2),8-hours(T3),16-hours(T4),24-hours(T5) and 48-hours(T6).Results A significant increase of UF was observed in both groups,and the change of UF was more obvious in EN group compared with that of Dopa group(P<0.05).CCr was no difference between two groups.FEH2O was increased signicantly after treatment compared with that of before treatment(T0) in NE group(P<0.05),but no same change trend was observed in Dopa group.Moreover,FEH2O incresed significantly in NE group compared with that of the same time point in Dapa group(P<0.01).FENa in NE group was decreased signicantly after treatment(T4) compared with that of Dopa group at the same time point(P<0.05).Conclusion Norepinephrine was more effective to reverse the hemodynamic in septic shock patients with high cardiac index and low systemic vascular resistance index.