去甲肾上腺素联合多巴酚丁胺治疗感染性休克对患者血流动力学、血乳酸及CCr，FEH2O，FENa的影响

目的:探讨去甲肾上腺素联合多巴酚丁胺治疗感染性休克对患者血流动力学、血乳酸及肌酐清除率(CCr)、滤过水排泄分数(FEH_2O)、滤过钠排泄分数(FENa)的影响。方法:研究对象选自我院2013年1月~2016年12月收治的120例感染性休克患者,采取随机数字表将其分成两组,每组60例。两组患者均采用多巴酚丁胺治疗,观察组在此基础上联合采用去甲肾上腺素治疗,对照组给予多巴胺治疗,对比两组临床疗效以及治疗前后血流动力学指标、血乳酸、CCr、FEH_2O、FENa水平的变化。结果:两组治疗后6、12、24、48 h血乳酸、FENa水平逐渐下降,且均明显低于治疗前;CCr、FEH_2O水平逐渐升高,且均明显高于治疗前(P0.01)。观察组治疗后6、12、24、48 h血乳酸、FENa水平均显著低于对照组同时点(P0.01),FEH_2O水平显著高于对照组同时点(P0.01)。两组治疗后6、12、24、48 h MAP、SVRI均较治疗前显著升高,治疗后24、48 h CI较治疗前显著升高(P0.01),观察组治疗后6、12、24、48 h MAP较治疗前显著降低(P0.01),对照组治疗后6、12 h MAP较治疗前显著升高(P0.01),观察组治疗后6、12、24、48 h HR显著低于对照组,SVRI显著高于对照组(P0.01)。观察组治疗28 d病死率为18.33%,对照组为35.00%,观察组病死率明显低于对照组(P0.05)。结论:去甲肾上腺素联合多巴酚丁胺治疗感染性休克可有效改善患者的血流动力学,降低血乳酸水平,改善肾脏灌注和患者预后。

Effects of Norepinephrine Combined with Dobutamine on Hemodynamics, Blood Lactic Acid, CCr, FEH2O and FENa of Patients with Septic Shock

ABSTRACT Objective: To explore the effects of norepinephrine combined with dobutamine on the hemodynamics, blood lactic acid, creatinine clearance rate (CCr), fractional excretion of H2O (FEH₂O) and fractional excretion of sodium (FENa) of patients with sep- tic shock. Methods: 120 cases of patients with septic shock from January 2016 to December 2016 were selected as the research objectives and randomly divided into two groups with 60 cases in each group. Dobutamine was given to both groups, then norepinephrine was addi- tionally given to the observation group, dopamine was additionally given to the control group. The clinical effect, changes of hemody- namics, blood lactic acid, CCr, FEH₂O and FENa levels before and after treatment were compared between two groups. Results: The blood lactic acid and FENa levels of both groups were gradually decreased at 6, 12, 24 and 48 hours after treatment and were significantly lower than those before treatment; the CCr and FEH₂O levels were gradually increased and significantly higher than those before treat- ment (P<0.01). The blood lactic acid and FENa levels were gradually decreased at 6, 12, 24 and 48 hours after treatment and were signifi- cantly lower than those of the control group at same time (P<0.01), the FEH₂O level was significantly higher than that of the control group at the same time (P<0.01). The MAP, SVRI of both groups at 6, 12, 24 and 48 hours after treatment were significantly higher than those before treatment, but the CI at 24, 48 hours after treatment were significantly higher than those before treatment (P<0.01), the MAP of observation group at 6, 12, 24 and 48 hours after treatment were significantly lower than those before treatment (P<0.01), the MAP at 6, 12 hours after treatment were significantly higher than those before treatment (P<0.01), the HR of observation group at 6, 12, 24 and 48 hours after treatment were significantly lower than those of the control group, but SVRI was significantly higher than those of the con- trol group(P<0.01). The mortality of observation group was 18.33% at 28th days after treatment, which was 35.00% in the control group and significantly higher than that of the observation group(P<0.05). Conclusion: Norepinephrine combined with dobutamine could im- prove the hemodynamics, reduce the blood lactate level, improve the renal perfusion and prognosis of patients with septic shock.