Ibsen M, Jørgensen V L, Perner A
Department of Intensive Care 4131, Rigshospitalet, Blegdamsvej 9, DK-2199 Copenhagen, Denmark.
Acta Anaesthesiol Scand. 2007 Sep;51(8):1079-84. doi: 10.1111/j.1399-6576.2007.01392.x.
To investigate the effect of different doses of norepinephrine (noradrenaline) on luminal concentrations of L-lactate in the rectum and stomach in patients with fluid-resuscitated septic shock.
This was a paired cross-over study in which the dose of norepinephrine was titrated to mean arterial blood pressures (MAPs) of 65 and 85 mmHg in random sequence. It was performed in a mixed intensive care unit at a university hospital. Eight patients with fluid-resuscitated septic shock requiring norepinephrine (>0.1 microg/kg/min) were included. Patients were treated with norepinephrine to a MAP of either 65 or 85 mmHg for 2 h. After a 'washout' period of 2 h, the dose of norepinephrine was titrated to the other endpoint of MAP for another 2 h. The concentrations of L-lactate in the rectal and gastric lumen were estimated by 1-h equilibrium dialysis during the second hour of the treatment periods.
MAP and central venous oxygen saturation were increased by increasing the dose of norepinephrine [median (range) (microg/kg/min): 0.07 (0.00-0.60) and 0.18 (0.11-1.00) at MAPs of 65 and 85 mmHg, respectively], whereas the metabolic markers were unaffected [luminal concentrations (mmol/l) of L-lactate in the rectum of 1.9 (0.8-6.4) and 1.8 (0.9-5.7) (P =0.94) and in the stomach of 1.1 (0.1-10.0) and 1.3 (0.3-9.7) (P =0.88) at MAPs of 65 and 85 mmHg, respectively].
In this small study, luminal concentrations of L-lactate in the rectum and stomach were unaffected by norepinephrine at low to moderate doses. These data suggest that norepinephrine may not increase luminal concentrations of l-lactate in the gut in patients with fluid-resuscitated septic shock.
研究不同剂量去甲肾上腺素（去甲肾上腺素）对液体复苏的感染性休克患者直肠和胃腔内L-乳酸浓度的影响。
这是一项配对交叉研究，去甲肾上腺素剂量随机滴定至平均动脉血压（MAP）65和85 mmHg。研究在大学医院的混合重症监护病房进行。纳入8例需要去甲肾上腺素（>0.1μg/kg/min）进行液体复苏的感染性休克患者。患者接受去甲肾上腺素治疗使MAP达到65或85 mmHg，持续2小时。经过2小时的“洗脱”期后，去甲肾上腺素剂量再滴定至另一个MAP终点，持续2小时。在治疗期的第二个小时，通过1小时平衡透析估计直肠和胃腔内L-乳酸的浓度。
随着去甲肾上腺素剂量增加，MAP和中心静脉血氧饱和度升高[在MAP为65和85 mmHg时，中位数（范围）（μg/kg/min）分别为0.07（0.00 - 0.60）和0.18（0.11 - 1.00）]，而代谢指标未受影响[在MAP为65和85 mmHg时，直肠内L-乳酸的腔内浓度（mmol/l）分别为1.9（0.8 - 6.4）和1.8（0.9 - 5.7）（P = 0.94），胃内分别为1.1（0.1 - 10.0）和1.3（0.3 - 9.7）（P = 0.88）]。
在这项小型研究中，低至中等剂量的去甲肾上腺素未影响直肠和胃腔内L-乳酸的浓度。这些数据表明，去甲肾上腺素可能不会增加液体复苏的感染性休克患者肠道内L-乳酸的腔内浓度。
