脓毒性休克患者平均动脉压升高：对氧变量和肾功能的影响。

Increasing mean arterial pressure in patients with septic shock: effects on oxygen variables and renal function.

作者信息

Bourgoin Aurélie, Leone Marc, Delmas Anne, Garnier Franck, Albanèse Jacques, Martin Claude

机构信息

Department of Intensive Care Medicine and Trauma Center, Hospital Nord, 13915 Marseille Cedex 20, France.

出版信息

Crit Care Med. 2005 Apr;33(4):780-6. doi: 10.1097/01.ccm.0000157788.20591.23.

DOI:10.1097/01.ccm.0000157788.20591.23

PMID:15818105

Abstract

OBJECTIVE

To measure the effects of increasing mean arterial pressure on oxygen variables and renal function in septic shock.

DESIGN

Prospective, open-label, randomized, controlled study.

SETTING

Medical-surgical intensive care unit of a tertiary care teaching hospital.

PATIENTS

Twenty-eight patients with a diagnosis of septic shock who required fluid resuscitation and pressor agents to increase and maintain mean arterial pressure > or =60 mm Hg.

INTERVENTIONS

Patients were treated with fluid and norepinephrine to achieve and maintain a mean arterial pressure of 65 mm Hg. Then they were randomized in two groups: In the first group (control group, n = 14), mean arterial pressure was maintained at 65 mm Hg, and in the second group (n = 14), mean arterial pressure was increased to 85 mm Hg by increasing the dose of norepinephrine.

MEASUREMENTS AND MAIN RESULTS

Hemodynamic variables (mean arterial pressure, heart rate, mean pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac index, systemic vascular resistance index, pulmonary vascular resistance index, left and right ventricular stroke indexes), metabolic variables (oxygen delivery, oxygen consumption-calorimetric method, arterial lactate), and renal function variables (urine flow, serum creatinine, creatinine clearance) were measured. After introduction of norepinephrine, similar values of hemodynamic, metabolic, and renal function variables were obtained in both groups. No changes were observed in group 1 during the study period. Increasing mean arterial pressure from 65 to 85 mm Hg with norepinephrine in group 2 resulted in a significant increase in cardiac index from 4.8 (3.8-6.0) to 5.8 (4.3-6.9) L.min.m. Arterial lactate and oxygen consumption did not change. No changes were observed in renal function variables: urine flow, 63 (14-127) and 70 (15-121) mL; serum creatinine, 170 (117-333) and 153 (112-310) mumol.L; and creatinine clearance, 50 (12-77) and 67 (13-89) mL.min.1.73 m.

CONCLUSIONS

Increasing mean arterial pressure from 65 to 85 mm Hg with norepinephrine neither affects metabolic variables nor improves renal function.

摘要

目的

测量升高平均动脉压对感染性休克患者氧变量及肾功能的影响。

设计

前瞻性、开放标签、随机对照研究。

地点

一所三级护理教学医院的内科-外科重症监护病房。

患者

28例诊断为感染性休克的患者，需要液体复苏及使用血管升压药以升高并维持平均动脉压≥60 mmHg。

干预措施

患者接受液体及去甲肾上腺素治疗，以达到并维持平均动脉压65 mmHg。然后将他们随机分为两组：第一组（对照组，n = 14），平均动脉压维持在65 mmHg；第二组（n = 14），通过增加去甲肾上腺素剂量将平均动脉压升高至85 mmHg。

测量指标及主要结果

测量血流动力学变量（平均动脉压、心率、平均肺动脉压、肺动脉闭塞压、心脏指数、全身血管阻力指数、肺血管阻力指数、左右心室每搏指数）、代谢变量（氧输送、氧消耗-量热法、动脉血乳酸）及肾功能变量（尿流量、血清肌酐、肌酐清除率）。在使用去甲肾上腺素后，两组的血流动力学、代谢及肾功能变量值相似。研究期间，第一组未观察到变化。第二组中，使用去甲肾上腺素将平均动脉压从65 mmHg升高至85 mmHg，导致心脏指数从4.8（3.8 - 6.0）显著升高至5.8（4.3 - 6.9）L·min·m。动脉血乳酸及氧消耗未改变。肾功能变量未观察到变化：尿流量，分别为63（14 - 127）和70（15 - 121）mL；血清肌酐，分别为170（117 - 333）和153（112 - 310）μmol/L；肌酐清除率，分别为50（12 - 77）和67（13 - 89）mL·min·1.73 m。