多巴酚丁胺应激试验对感染性休克患者的预后评价

摘要

目的：观察多巴酚丁胺应激试验对感染性休克患者的预后价值.方法：感染性休克患者静脉持续滴注多巴酚丁胺10μg·kg-1·min-1 h，观察患者全身血流动力学和氧代谢的改变，氧耗量(VO2)增加15％以上者为试验阳性.结果：47例感染性休克患者中，21例应激试验阳性，26例阴性.阳性组应用多巴酚丁胺后心指数(CI)增加18.1％，氧输送增加12.7％，VO2增加37.6％，氧摄取率增加18.0％，体血管阻力指数降低18.5％.阴性组CI增加11.5％，氧输送、VO2和氧摄取率均无明显改变.阴性组患者病死率76.9％，阳性组为33.3％(P＜0.05).结论：多巴酚丁胺应激试验可作为感染性休克患者预后评估的动态指标.%AIM: To evaluate the prognostic effect of dobutamine stress test in patients with septic shock. METHODS: Patients with septic shock received intravenous infusion of dobutamine at 10 μg·kg-1·min-1 for 1 h. Hemodynamics and oxygen metabolism was observed. A patient who was able to increase oxygen consumption index (Vo2) by＞15％ was designated as a responder to the test. RESULTS: In 47 patients with septic shock, twenty one responders and twenty six nonresponders were identified, and mortality was 33.3％ and 76.9％ respectively. After the dobutamine infusion, the responders showed increases in cardiac index (18.1％), oxygen delivery index (12.7％), Vo2 (38.6％), and oxygen extraction ratio (18.0％), and reductions in systemic vascular resistance index (18.5％). The nonresponders demonstrated increases in cardiac index (11.5％), but no change in oxygen delivery, Vo2, and oxygen extraction ratio. CONCLUSION: Dobutamine stress test might be a good predictor of outcome in patients with septic shock.