去甲肾上腺素、肾上腺素及去甲肾上腺素-多巴酚丁胺对感染性休克病人全身及胃粘膜氧代谢的影响

摘要

AIM: To compare the effects of dopamine, norepinephrine, epinephrine, and the combination of norepinephrine and dobutamine on systemic and gastric mucosal oxygen metabolism in patients with septic shock.METHODS: Sixteen patients with septic shock were enrolled in the present study. Each patient received dopamine firstly, then in a random succession epinephrine, norepinephrine, or norepinephrine-dobutamine, a mean systemic arterial pressure adjusted to ＞ 9.31 kPa.After 120 rain of each treatment, hemodynamic, oxygen metabolic, and gastric mucosal parameters were obtained.RESULTS: Epinephrine induced a significant increase in heart rate compared with other three groups ( P ＜ 0.05),and a significant higher cardiac index compared with norepinephrine alone and norepinephrine-dobutamine ( P ＜ 0.05). Oxygen extraction ratio values were lower with epinephrine infusion as compared with other three groups (P ＜ 0.05 ). Arterial lactate concentrations decreased significantly with norepinephrine-dobutamine as compared with dopamine and epinephrine infusions ( P ＜0.05). As compared with epinephrine infusion, the gastric intramucosal pH values were higher with norepinephrine-dobutamine infusion (7.25 ± 0.09 vs 7.14 ±0.07, P ＜0.05). CONCLUSION: Dopamine, norepinephrine, epinephrine, or norepinephrine-dobutamine improved blood pressure. Epinephrine and dopamine had deleterious effect on oxygen metabolism, while norepinephrine plus low dose of dobutamine improved gastric mucosal perfusion and tissue oxygen utilization.%目的:比较多巴胺、去甲肾上腺素、肾上腺素及去甲肾上腺素-多巴酚丁胺对感染性休克患者全身及胃粘膜氧代谢的影响.方法:首先用多巴胺,然后随机应用肾上腺素、去甲肾上腺素,或去甲肾上腺素-多巴酚丁胺,调整剂量维持平均动脉压＞9.31 kPa.药物注射后120 min,记录血流动力学、氧代谢及胃粘膜pH参数.结果:与其它三组比较,肾上腺素使心率明显增加(P＜0.05),心排指数明显高于去甲肾上腺素组或去甲肾上腺素-多巴酚丁胺组(P＜0.05),氧摄取率明显低于其它三组(P＜0.05).与多巴胺、肾上腺素比较,去甲肾上腺素-多巴酚丁胺合用时动脉血乳酸值明显降低(P＜0.05).与肾上腺素比较,去甲肾上腺素-多巴酚丁胺合用时胃粘膜pH值明显增加(7.25±0.09 vs 7.14±0.07,P＜0.05).结论:多巴胺、去甲肾上腺素、肾上腺素及去甲肾上腺素-多巴酚丁胺均能升高血压.但是肾上腺素和多巴胺使氧代谢恶化,而去甲肾上腺素与小剂量多巴酚丁胺合用可改善胃粘膜灌注和组织氧利用.