Morelli A, Ertmer C, Lange M, Dünser M, Rehberg S, Van Aken H, Pietropaoli P, Westphal M
Department of Anesthesiology and Intensive Care, University of Rome La Sapienza, Viale del Policlinico 155, 00161 Rome, Italy.
Br J Anaesth. 2008 Apr;100(4):494-503. doi: 10.1093/bja/aen017. Epub 2008 Feb 27.
Terlipressin bolus infusion may reduce cardiac output and global oxygen supply. The present study was designed to determine whether dobutamine may counterbalance the terlipressin-induced depression in mixed-venous oxygen saturation (Svo) in patients with catecholamine-dependent septic shock.
Prospective, randomized, controlled study performed in a university hospital intensive care unit. Septic shock patients requiring a continuous infusion of norepinephrine (0.9 microg kg(-1) min(-1)) to maintain mean arterial pressure (MAP) at 70 (sd 5) mm Hg were randomly allocated to be treated either with (i) sole norepinephrine infusion (control, n=20), (ii) a single dose of terlipressin 1 mg (n=19), or (iii) a single dose of terlipressin 1 mg followed by dobutamine infusion titrated to reverse the anticipated reduction in Svo2 (n=20). Systemic, pulmonary, and regional haemodynamic variables were obtained at baseline and after 2 and 4 h. Laboratory surrogate markers of organ (dys)function were tested at baseline and after 12 and 24 h.
Terlipressin (with and without dobutamine) infusion preserved MAP at 70 (5) mm Hg, while allowing to reduce norepinephrine requirements to 0.17 (0.2) and 0.2 (0.2) microg kg(-1) min(-1), respectively [vs1.4 (0.3) microg kg(-1) min(-1) in controls at 4 h; each P<0.001]. The terlipressin-linked decrease in Svo2 was reversed by dobutamine at a mean dose of 20 (8) microg kg(-1) min(-1) [Svo2 at 4 h: 59 (11)% vs 69 (12)%, P=0.028].
In human catecholamine-dependent septic shock, terlipressin (with and without concomitant dobutamine infusion) increases MAP and markedly reduces norepinephrine requirements. Although no adverse events were noticed in the present study, potential benefits of increasing Svo2 after terlipressin bolus infusion need to be weighted against the risk of cardiovascular complications resulting from high-dose dobutamine.
特利加压素大剂量输注可能会降低心输出量和全身氧供。本研究旨在确定多巴酚丁胺是否可抵消特利加压素引起的儿茶酚胺依赖性感染性休克患者混合静脉血氧饱和度（Svo₂）降低。
在一家大学医院重症监护病房进行的前瞻性、随机、对照研究。需要持续输注去甲肾上腺素（0.9微克·千克⁻¹·分钟⁻¹）以维持平均动脉压（MAP）在70（标准差5）毫米汞柱的感染性休克患者被随机分配接受以下治疗：（i）单纯去甲肾上腺素输注（对照组，n = 20）；（ii）单次剂量的特利加压素1毫克（n = 19）；或（iii）单次剂量的特利加压素1毫克，随后输注多巴酚丁胺并滴定剂量以逆转预期的Svo₂降低（n = 20）。在基线以及2小时和4小时后获取全身、肺和区域血流动力学变量。在基线以及12小时和24小时后检测器官（功能障碍）的实验室替代标志物。
输注特利加压素（无论是否联合多巴酚丁胺）可将MAP维持在70（5）毫米汞柱，同时可将去甲肾上腺素需求量分别降至0.17（0.2）和0.2（0.2）微克·千克⁻¹·分钟⁻¹[4小时时对照组为1.4（0.3）微克·千克⁻¹·分钟⁻¹；P均<0.001]。多巴酚丁胺以平均剂量20（8）微克·千克⁻¹·分钟⁻¹逆转了特利加压素相关的Svo₂降低[4小时时Svo₂：59（11）%对69（12）%，P = 0.028]。
在人类儿茶酚胺依赖性感染性休克中，特利加压素（无论是否联合多巴酚丁胺输注）可提高MAP并显著降低去甲肾上腺素需求量。尽管本研究未观察到不良事件，但特利加压素大剂量输注后提高Svo₂的潜在益处需要与高剂量多巴酚丁胺导致心血管并发症的风险相权衡。
