多巴酚丁胺对感染性休克引起的急性呼吸窘迫综合征患者相关指标的影响

发布时间：2018-06-07 01:46

本文选题：多巴酚丁胺 + 感染性休克　；参考：《中国药房》2017年21期

【摘要】：目的:探讨多巴酚丁胺对感染性休克引起的急性呼吸窘迫综合征(ARDS)患者血流动力学、组织灌注及呼吸功能的影响。方法:26例感染性休克引起的ARDS患者均给予盐酸多巴酚丁胺注射液5μg/(kg·min),持续泵注20 min,后每20 min增加5μg/(kg·min),直至15μg/(kg·min),持续泵注维持6 h,泵注过程中维持平均动脉压(MAP)在65 mm Hg左右。记录所有患者用药前,用药后6、24、48 h的血流动力学指标[心率(HR)、平均动脉压(MAP)、心输出量(CO)、每搏输出量(SV)、全心舒张末期容积(GEDV)、胸腔内血容量指数(ITBI)、血管外肺水指数(ELWI)、外周血管阻力指数(SVRI)]、组织灌注量指标(去甲肾上腺素、尿量、血氧饱和度、血乳酸)、呼吸机参数指标(呼气末正压、每分钟通气量、呼吸频率、吸气峰压、平台压)。结果:患者用药前后HR、MAP、GEDV、ITBI、血氧饱和度、血乳酸、呼吸频率比较,差异均无统计学意义(P0.05)。患者用药后6、24、48 h的CO、SV、尿量、每分钟通气量均显著高于用药前,且随用药时间延长逐渐升高;用药后ELWI、SVRI、呼吸末正压、吸气峰压、平台压均显著低于用药前,且随用药时间延长逐渐降低,差异均有统计学意义(P0.05)。患者用药后24、48 h的去甲肾上腺素均显著低于用药前及用药后6 h,差异均有统计学意义(P0.05),但用药前与用药后6 h比较,差异无统计学意义(P0.05)。结论:早期应用多巴酚丁胺可改善感染性休克引起的ARDS患者的ELWI、组织灌注及呼吸功能,稳定血流动力学。
[Abstract]:Aim: to investigate the effects of dobutamine on hemodynamics, tissue perfusion and respiratory function in patients with acute respiratory distress syndrome (ARDS) caused by septic shock. Methods Twenty six patients with ARDS caused by septic shock were treated with dobutamine hydrochloride injection of 5 渭 g/(kg for 20 minutes, followed by an increase of 5 渭 g/(kg min for every 20 min until 15 渭 g/(kg min, and the mean arterial pressure during infusion was about 65 mm Hg. Before all the patients were treated, The hemodynamic parameters were measured at 6 and 24 hours after treatment [heart rate (HRT), mean arterial pressure (map), cardiac output, cardiac output (SVV), total cardiac end-diastolic volume (GedV), intrathoracic blood volume index (ITBI), extravascular pulmonary water index (ELWI), peripheral vascular resistance index (SVRI)]. Woven perfusion index (norepinephrine, norepinephrine, Urine volume, blood oxygen saturation, blood lactate, ventilator parameters (positive end-expiratory pressure, ventilation volume per minute, respiratory rate, peak inspiratory pressure, plateau pressure). Results: there was no significant difference in blood oxygen saturation, blood lactic acid and respiratory rate before and after treatment with HRP MAPG GEDVV I. The volume of COV, urine volume per minute after treatment was significantly higher than that before administration, and gradually increased with the prolongation of medication time, and the positive end-respiratory pressure, inspiratory peak pressure and plateau pressure were significantly lower than those before medication. And with the prolongation of drug use time, the difference was statistically significant (P 0.05). The norepinephrine levels were significantly lower than those before and 6 hours after treatment, but there was no significant difference between the two groups before and 6 hours after administration. Conclusion: early administration of dobutamine can improve ELWI, tissue perfusion and respiratory function and stabilize hemodynamics in ARDS patients caused by septic shock.
【作者单位】：安徽医科大学第一附属医院重症医学科;
【基金】：国家自然科学基金资助项目(No.81201488)
【分类号】：R459.7;R563.8

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