【摘要】：背景： 感染性休克是一種臨床常見的綜合征,由于休克導(dǎo)致的多器官衰竭致死率很高,這也是目前重癥醫(yī)學(xué)科(ICU)內(nèi)最主要的死亡原因。近年來,抗感染治療和器官功能支持技術(shù)取得了長足的進步,但感染性休克的病死率仍高達30%-70%所以降低感染性休克導(dǎo)致的死亡是全球臨床醫(yī)師面臨的共同難題。感染性休克早期血流動力學(xué)通常以高排低阻為特征,并可導(dǎo)致持續(xù)的低血壓和組織器官的低灌注。頑固性休克是ICU患者的主要死亡原因,約占ICU死亡病例的50%。休克患者經(jīng)過積極的液體復(fù)蘇,血壓仍然不能維持時,應(yīng)給予血管活性藥物治療,以維持適當(dāng)?shù)膭用}血壓和氧輸送,保證內(nèi)臟灌注和組織氧代謝。去甲腎上腺素及多巴胺作為臨床最主要的血管活性藥物,在作為最佳血管活性藥物的選擇這個問題上一直存在很大的分歧。 目的： 關(guān)于多巴胺(Dopamine)及去甲腎上腺素(Norepinephrine)在感染性休克患者治療中的對比,比較兩者對復(fù)蘇效果、組織關(guān)注影響的差異。 對象： 選擇2009年10月-2012年2月寧波大學(xué)醫(yī)學(xué)院附屬醫(yī)院重癥監(jiān)護病房收住的206例腹部外科手術(shù)后感染性休克患者。 方法： 1)對入選的206例腹部外科手術(shù)后感染性休克患者按隨機原則分為多巴胺組(DA組)和去甲腎上腺組(NE組)進行升壓治療。 2)分別比較兩組患者給藥前(To)及給藥后lhr(T1)、3hr (T3)和6hr (T6)四個時間點的血流動力學(xué)指標：平均動脈壓(MAP)、心率(HR)、肺毛細血管楔壓(PCWP)、心排出量指數(shù)(CI)、體循環(huán)血管阻力指數(shù)(SVRI)。 3)分別比較兩組患者給藥前(T0)及給藥后lhr (T1)、3hr (T3)和6hr (T6)四個時間點的氧代謝指標：氧供指數(shù)(D02I)、氧耗指數(shù)(VO2I)、氧攝取率(O2ext)、乳酸清除率以及混合靜脈血氧飽和度(Sv02)。 4)比較兩組患者6hr后的復(fù)蘇率和28天后的死亡率。 結(jié)果： 1)與給藥前(T0)相比,在血流動力學(xué)指標比較中,NE組患者的SVRI、CI明顯高于DA組,HR明顯低于DA組, P0.05;； 2)與給藥前(T0)相比,在氧合指標比較中,NE組患者的VO2I、O2ext明顯高于DA組,DO2I明顯低于DA組, P0.05；在乳酸清除率及Sv02比較中,NE組患者的乳酸清除率以及SvO2≥65%的比例明顯高于DA組,P0.05。 3)NE組患者6小時復(fù)蘇成功率明顯高于DA組,P0.05。 結(jié)論： 1)去甲腎上腺素能夠更好的提高感染性休克患者的6小時復(fù)蘇成功率。 2)去甲腎上腺素能夠更好的維持休克患者的血流動力學(xué)狀態(tài),提高感染患者的組織氧代謝,并且改善體循環(huán)血管阻力指數(shù)、氧攝取率更明顯。 3)去甲腎上腺素更適合感染性休克的治療,值得臨床推廣應(yīng)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，

本文編號：2202080