多巴胺及去甲肾上腺素在感染性休克患者治疗中的对比研究

发布时间：2018-08-24 21:22

【摘要】：背景： 感染性休克是一种临床常见的综合征,由于休克导致的多器官衰竭致死率很高,这也是目前重症医学科(ICU)内最主要的死亡原因。近年来,抗感染治疗和器官功能支持技术取得了长足的进步,但感染性休克的病死率仍高达30%-70%所以降低感染性休克导致的死亡是全球临床医师面临的共同难题。感染性休克早期血流动力学通常以高排低阻为特征,并可导致持续的低血压和组织器官的低灌注。顽固性休克是ICU患者的主要死亡原因,约占ICU死亡病例的50%。休克患者经过积极的液体复苏,血压仍然不能维持时,应给予血管活性药物治疗,以维持适当的动脉血压和氧输送,保证内脏灌注和组织氧代谢。去甲肾上腺素及多巴胺作为临床最主要的血管活性药物,在作为最佳血管活性药物的选择这个问题上一直存在很大的分歧。 目的： 关于多巴胺(Dopamine)及去甲肾上腺素(Norepinephrine)在感染性休克患者治疗中的对比,比较两者对复苏效果、组织关注影响的差异。 对象： 选择2009年10月-2012年2月宁波大学医学院附属医院重症监护病房收住的206例腹部外科手术后感染性休克患者。 方法： 1)对入选的206例腹部外科手术后感染性休克患者按随机原则分为多巴胺组(DA组)和去甲肾上腺组(NE组)进行升压治疗。 2)分别比较两组患者给药前(To)及给药后lhr(T1)、3hr (T3)和6hr (T6)四个时间点的血流动力学指标：平均动脉压(MAP)、心率(HR)、肺毛细血管楔压(PCWP)、心排出量指数(CI)、体循环血管阻力指数(SVRI)。 3)分别比较两组患者给药前(T0)及给药后lhr (T1)、3hr (T3)和6hr (T6)四个时间点的氧代谢指标：氧供指数(D02I)、氧耗指数(VO2I)、氧摄取率(O2ext)、乳酸清除率以及混合静脉血氧饱和度(Sv02)。 4)比较两组患者6hr后的复苏率和28天后的死亡率。 结果： 1)与给药前(T0)相比,在血流动力学指标比较中,NE组患者的SVRI、CI明显高于DA组,HR明显低于DA组, P0.05;； 2)与给药前(T0)相比,在氧合指标比较中,NE组患者的VO2I、O2ext明显高于DA组,DO2I明显低于DA组, P0.05；在乳酸清除率及Sv02比较中,NE组患者的乳酸清除率以及SvO2≥65%的比例明显高于DA组,P0.05。 3)NE组患者6小时复苏成功率明显高于DA组,P0.05。 结论： 1)去甲肾上腺素能够更好的提高感染性休克患者的6小时复苏成功率。 2)去甲肾上腺素能够更好的维持休克患者的血流动力学状态,提高感染患者的组织氧代谢,并且改善体循环血管阻力指数、氧摄取率更明显。 3)去甲肾上腺素更适合感染性休克的治疗,值得临床推广应用。
[Abstract]:Background: septic shock is a common clinical syndrome. The mortality of multiple organ failure due to shock is very high, which is the main cause of death in (ICU). In recent years, great progress has been made in anti-infective therapy and organ function support technology, but the mortality of septic shock is still up to 30-70%. Therefore, reducing the mortality caused by septic shock is a common problem facing clinicians all over the world. Early stage of septic shock is usually characterized by high excretion and low resistance, which can lead to persistent hypotension and hypoperfusion of tissues and organs. Refractory shock is the main cause of death in patients with ICU, accounting for about 50% of ICU deaths. Patients with shock should be treated with vasoactive drugs to maintain proper arterial blood pressure and oxygen delivery and ensure visceral perfusion and tissue oxygen metabolism when blood pressure is still unable to maintain after positive fluid resuscitation. Norepinephrine and dopamine are the most important vasoactive drugs in clinic. Aim: to compare the effect of dopamine (Dopamine) and norepinephrine (Norepinephrine) in the treatment of septic shock. Participants: 206 patients with septic shock after abdominal surgery were enrolled in intensive care unit of affiliated Hospital of Ningbo University Medical College from October 2009 to February 2012. Methods: 1) two hundred and six patients with septic shock after abdominal surgery were randomly divided into dopamine group (DA group) and noradrenals group (NE group). Hemodynamic indices of (To) before administration and lhr (T1) 3hr (T3) and 6hr (T6) at four time points: mean arterial pressure (MAP), pulmonary capillary wedge pressure (HR), (PCWP), cardiac output index (CI), systemic vascular resistance index (SVRI). 3) Do not compare the oxygen metabolism indexes of lhr (T1) 3hr (T3) and 6hr (T6) before and after administration: oxygen supply index (D02I), oxygen consumption index (VO2I), oxygen uptake rate (O2ext), lactate clearance and mixed venous oxygen saturation (Sv02). The rate of resuscitation after 6hr and the mortality after 28 days were compared between the two groups. Results: 1) compared with before administration (T0), the SVRI,CI of NE group was significantly higher than that of DA group (P 0 05), and 2) compared with that before administration (T 0), the SVRI,CI of NE group was significantly higher than that of DA group (P 0 0). Compared with the oxygenation index, the VO2I,O2ext in the NE group was significantly higher than that in the DA group, and the level of DO2I in the DA group was significantly lower than that in the DA group (P0.05). The lactate clearance rate and the percentage of SvO2 鈮，

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