多巴胺对感染性休克的心血管反应及预后早期预测：一项前瞻性多中心研究

Cardiovascular response to dopamine and early prediction of outcome in septic shock: a prospective multiple-center study.

作者信息

Levy Bruno, Dusang Benjamin, Annane Djillali, Gibot Sebastien, Bollaert Pierre-Edouard

机构信息

Réanimation Médicale, Hôpital Central, Nancy Cedex, France.

出版信息

Crit Care Med. 2005 Oct;33(10):2172-7. doi: 10.1097/01.ccm.0000181297.14319.3c.

DOI:10.1097/01.ccm.0000181297.14319.3c

PMID:16215366

Abstract

OBJECTIVES

To compare mortality rates between dopamine-sensitive (Dopa-S) and dopamine-resistant (Dopa-R) septic shock patients, the latter group defined by a mean arterial pressure <70 mm Hg despite the use of 20 mug/kg/min dopamine.

DESIGN

A human, prospective observational, multiple-center, clinical trial.

SETTING

Ten intensive care units from ten hospitals.

PATIENTS

110 patients with septic shocks.

INTERVENTIONS

Following volume resuscitation, patients were treated by a rapid increase in dopamine infusion from 10 to 20 mug/kg/min. If mean arterial pressure remained <70 mm Hg, dopamine treatment was promptly switched to norepinephrine or epinephrine.

MEASUREMENTS AND MAIN RESULTS

Dopamine sensitivity, arterial gas, lactate, and organ system failure scores were measured at admission and after 6, 12, 24, 48, 72, 96, and 120 hrs. The overall 28-day mortality rate was 54% for the entire population under study. In multivariate analysis, independent predictors of death were dopamine resistance (odds ratio, 9.5; 95% confidence interval, 3-25), arterial lactate >3.5 mmol/L (odds ratio, 1.75; 95% confidence interval, 1.06-2.55), and Sepsis-related Organ Failure Assessment score >10 (odds ratio, 1.40; 95% confidence interval, 1.07-2.12). Of the 110 patients studied, 66 were observed to be resistant to dopamine (60%). In the Dopa-S group, the 28-day mortality rate was 16% (seven of 44 patients) compared with 78% (52 of 66 patients) in the Dopa-R group (p = .0006). The capacity of dopamine resistance to predict death was associated with a sensitivity of 84% and a specificity of 74%. At 24 hrs, the association of dopamine resistance to a lactate level >3.5 mmol/L improved the prognostic value (sensitivity, 90%, specificity, 92%).

CONCLUSIONS

Dopamine sensitivity is associated with decreased mortality rate. Early recognition of dopamine resistant septic shock could allow for better screening of patients with an ominous prognosis.

摘要

目的

比较多巴胺敏感（Dopa-S）和多巴胺抵抗（Dopa-R）的感染性休克患者的死亡率，后者定义为尽管使用20μg/kg/min多巴胺但平均动脉压仍<70 mmHg。

设计

一项前瞻性、多中心、人体临床试验。

地点

来自十家医院的十个重症监护病房。

患者

110例感染性休克患者。

干预措施

液体复苏后，患者多巴胺输注速度从10μg/kg/min迅速增至20μg/kg/min。如果平均动脉压仍<70 mmHg，多巴胺治疗立即换用去甲肾上腺素或肾上腺素。

测量指标及主要结果

入院时以及6、12、24、48、72、96和120小时后测量多巴胺敏感性、动脉血气、乳酸和器官系统衰竭评分。研究的整个人群28天死亡率为54%。多因素分析中，死亡的独立预测因素为多巴胺抵抗（比值比，9.5；95%置信区间，3 - 25）、动脉血乳酸>3.5 mmol/L（比值比，1.75；95%置信区间，1.06 - 2.55）以及脓毒症相关器官衰竭评估评分>10（比值比，1.40；95%置信区间，1.07 - 2.12）。在研究的110例患者中，66例对多巴胺抵抗（60%）。Dopa-S组28天死亡率为16%（44例患者中的7例），而Dopa-R组为78%（66例患者中的52例）（p = 0.0006）。多巴胺抵抗预测死亡的能力敏感性为84%，特异性为74%。在24小时时，多巴胺抵抗与乳酸水平>3.5 mmol/L相结合可提高预后价值（敏感性，90%，特异性，92%）。