目的：探讨多巴胺和去甲肾上腺素用于心源性休克患者的疗效。方法选取2007年6月至2014年6月广州军区广州总医院心源性休克患者60例，随机分为多巴胺组和去甲肾上腺素组，每组30例，分别给予盐酸多巴胺5～20μg／（ kg・ min）和重酒石酸去甲肾上腺素0．05～2．0μg／（kg・ min），比较两组患者死亡率、治疗24 h后的心率（HR）、平均动脉压（MAP）和血乳酸水平以及用药期间心律失常的发生率。结果相比去甲肾上腺素组，多巴胺组重症医学科（ ICU）死亡率、治疗24 h后的HR水平和用药期间心房颤动发生率高，差异有统计学意义（ P＜0．05）。两组患者住院死亡率、随访28 d、6个月、1年死亡率差异均无统计学意义（P＞0．05）；治疗24 h后MAP和血乳酸水平差异无统计学意义（P＞0．05）；用药期间室性心动过速和心室颤动发生率差异无统计学意义（P＞0．05）。结论相比多巴胺，去甲肾上腺素用于心源性休克患者可有效降低ICU死亡率，减慢心率，减少心房颤动的发生，但不降低长期死亡率。%Objective To determine the efficiency of dopamine and norepinephrine in treatment of cardiogenic shock .Methods Sixty cardiogenic shock patients admitted in our hospital from June 2007 to June 2014 were subjected in this study , and then randomly divided into 2 groups (n=30), treated with 5 ~20 μg/(kg・ min) dopamine and 0.05 ~2.0 μg/(kg・ min) norepinephrine, respectively.The mortality, heart rate after 24 hours’ treatment, mean arterial pressure (MAP), blood lactic acid level and incidence of arrhythmia during the treatment were compared between the 2 groups.Results The mortality in Intensive Care Unit (ICU), HR after 24 hours’ treatment and incidence of arrhythmia were significantly higher in the dopamine group than in the norepinephrine group (P<0.05).But there were no significant differences in the in-hospital mortality and the mortalities in 28 d, 6 months and 1 year after discharge (P>0.05).No differences were seen in the MAP and blood lactic acid levels between two groups after 24 hours’ treatment (P>0.05), neither in the occurrences of ventricular tachycardia and fibrillation during the treatment ( P >0.05).Conclusion Compared with dopamine , norepinephrine treatment can effectively lower ICU mortality , decrease HR and reduce atrial fibrillation , but doesn’t affect long-term mortality in treatment of cardiogenic shock .
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