Sakr Yasser, Reinhart Konrad, Vincent Jean-Louis, Sprung Charles L, Moreno Rui, Ranieri V Marco, De Backer Daniel, Payen Didier
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Crit Care Med. 2006 Mar;34(3):589-97. doi: 10.1097/01.CCM.0000201896.45809.E3.
The optimal adrenergic support in shock is controversial. We investigated whether dopamine administration influences the outcome from shock.
Cohort, multiple-center, observational study.
One hundred and ninety-eight European intensive care units.
All adult patients admitted to a participating intensive care unit between May 1 and May 15, 2002.
None.
Patients were followed up until death, until hospital discharge, or for 60 days. Shock was defined as hemodynamic compromise necessitating the administration of vasopressor catecholamines. Of 3,147 patients, 1,058 (33.6%) had shock at any time; 462 (14.7%) had septic shock. The intensive care unit mortality rate for shock was 38.3% and 47.4% for septic shock. Of patients in shock, 375 (35.4%) received dopamine (dopamine group) and 683 (64.6%) never received dopamine. Age, gender, Simplified Acute Physiology Score II, and Sequential Organ Failure Assessment score were comparable between the two groups. The dopamine group had higher intensive care unit (42.9% vs. 35.7%, p=.02) and hospital (49.9% vs. 41.7%, p=.01) mortality rates. A Kaplan-Meier survival curve showed diminished 30 day-survival in the dopamine group (log rank=4.6, p=.032). In a multivariate analysis with intensive care unit outcome as the dependent factor, age, cancer, medical admissions, higher mean Sequential Organ Failure Assessment score, higher mean fluid balance, and dopamine administration were independent risk factors for intensive care unit mortality in patients with shock.
This observational study suggests that dopamine administration may be associated with increased mortality rates in shock. There is a need for a prospective study comparing dopamine with other catecholamines in the management of circulatory shock.
休克时最佳的肾上腺素能支持存在争议。我们研究了给予多巴胺是否会影响休克的结局。
队列、多中心、观察性研究。
198个欧洲重症监护病房。
2002年5月1日至5月15日期间入住参与研究的重症监护病房的所有成年患者。
无。
对患者进行随访直至死亡、出院或60天。休克定义为需要使用血管加压儿茶酚胺进行血流动力学支持。3147例患者中，1058例（33.6%）曾在任何时间发生休克；462例（14.7%）为感染性休克。休克患者的重症监护病房死亡率为38.3%，感染性休克患者为47.4%。休克患者中，375例（35.4%）接受了多巴胺治疗（多巴胺组），683例（64.6%）从未接受过多巴胺治疗。两组患者的年龄、性别、简化急性生理学评分II和序贯器官衰竭评估评分具有可比性。多巴胺组的重症监护病房死亡率（42.9%对35.7%，p = 0.02）和医院死亡率（49.9%对41.7%，p = 0.01）更高。Kaplan-Meier生存曲线显示多巴胺组30天生存率降低（对数秩检验=4.6，p = 0.032）。在以重症监护病房结局为因变量的多变量分析中，年龄、癌症、内科入院、较高的平均序贯器官衰竭评估评分、较高的平均液体平衡量以及使用多巴胺是休克患者重症监护病房死亡的独立危险因素。
这项观察性研究表明，给予多巴胺可能与休克死亡率增加有关。有必要进行一项前瞻性研究，比较多巴胺与其他儿茶酚胺在循环性休克治疗中的效果。
