Hou Li-Chao, Li Shu-Zhi, Xiong Li-Ze, Chen Shao-Yang, Chen Min, Zhang Xi-Jing, Huo Ting-Ting, Wang Qiang, Wang Ya-Li, Hu Wen-Neng
Department of Anaesthesiology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Chin Med J (Engl). 2007 Apr 20;120(8):680-3.
Vasoactive drugs are often necessary for reversing hypotension in patients with severe infection. The standard for evaluating effects of vasoactive drugs should not only be based on the increase of arterial blood pressure, but also on the blood flow perfusion of internal organs. The effects of dopamine and metaraminol on the renal function of the patients with septic shock were investigated retrospectively in this study.
Ninety-eight patients with septic shock were divided into three groups according to the highest infusing rate of metaraminol, with the lightest infusing rate of (0.1 - 0.5, 0.6 - 1.0, > 1.0) microgxkg(-1)xmin(-1) in group A, B and C respectively. Urine output, mean arterial blood pressure (MAP), heart rate (HR), urine output, blood urea nitrogen (BUN), creatinine (CRE), urine albumin (U-ALB), urine beta(2)-microglubulin (Ubeta(2)-MG) and Apache III scores were recorded.
Before antishock therapy, hypotension, tachycardia and oliguria occurred to all the 98 patients with septic shock and CRE, BUN, U-ALB, Ubeta(2)-MG and Apache III scoring were abnormal in most cases. With the antishock therapy, MAP, HR, urine output, BUN and CRE in all patients returned gradually to normal (P < 0.05 or < 0.01 compared to those before antishock therapy). U-ALB, Ubeta(2)-MG output and Apache III scoring also reverted but remained abnormal (P < 0.01 compared to those before antishock therapy). No statistically significant differences in the changes of these indices with the time existed among the three groups (P > 0.05).
Dopamine and metaraminol when applied to the patients with septic shock could effectively maintain the circulatory stability and promote restoration of renal function.
血管活性药物对于逆转重症感染患者的低血压状态通常是必要的。评估血管活性药物疗效的标准不应仅基于动脉血压的升高，还应基于内脏器官的血流灌注情况。本研究回顾性调查了多巴胺和间羟胺对感染性休克患者肾功能的影响。
98例感染性休克患者根据间羟胺的最高输注速率分为三组，A组、B组和C组间羟胺的输注速率分别为最低（0.1 - 0.5、0.6 - 1.0、> 1.0）μg·kg⁻¹·min⁻¹。记录尿量、平均动脉压（MAP）、心率（HR）、尿量、血尿素氮（BUN）、肌酐（CRE）、尿白蛋白（U-ALB）、尿β₂-微球蛋白（Uβ₂-MG）及急性生理和慢性健康状况评分系统III（Apache III）评分。
98例感染性休克患者在抗休克治疗前均出现低血压、心动过速和少尿，大多数患者的CRE、BUN、U-ALB、Uβ₂-MG及Apache III评分均异常。随着抗休克治疗，所有患者的MAP、HR、尿量、BUN和CRE逐渐恢复正常（与抗休克治疗前相比，P < 0.05或< 0.01）。U-ALB、Uβ₂-MG的排出量及Apache III评分也有所恢复，但仍异常（与抗休克治疗前相比，P < 0.01）。三组间这些指标随时间变化的差异无统计学意义（P > 0.05）。
多巴胺和间羟胺应用于感染性休克患者时，可有效维持循环稳定并促进肾功能恢复。
