Morelli Andrea, Ertmer Christian, Rehberg Sebastian, Lange Matthias, Orecchioni Alessandra, Laderchi Amalia, Bachetoni Alessandra, D'Alessandro Mariadomenica, Van Aken Hugo, Pietropaoli Paolo, Westphal Martin
Department of Anesthesiology and Intensive Care, University of Rome, La Sapienza, Viale del Policlinico 155, Rome 00161, Italy.
Crit Care. 2008;12(6):R143. doi: 10.1186/cc7121. Epub 2008 Nov 18.
Previous findings suggest that a delayed administration of phenylephrine replacing norepinephrine in septic shock patients causes a more pronounced hepatosplanchnic vasoconstriction as compared with norepinephrine. Nevertheless, a direct comparison between the two study drugs has not yet been performed. The aim of the present study was, therefore, to investigate the effects of a first-line therapy with either phenylephrine or norepinephrine on systemic and regional hemodynamics in patients with septic shock.
We performed a prospective, randomized, controlled trial in a multidisciplinary intensive care unit in a university hospital. We enrolled septic shock patients (n = 32) with a mean arterial pressure below 65 mmHg despite adequate volume resuscitation. Patients were randomly allocated to treatment with either norepinephrine or phenylephrine infusion (n = 16 each) titrated to achieve a mean arterial pressure between 65 and 75 mmHg. Data from right heart catheterization, a thermodye dilution catheter, gastric tonometry, acid-base homeostasis, as well as creatinine clearance and cardiac troponin were obtained at baseline and after 12 hours. Differences within and between groups were analyzed using a two-way analysis of variance for repeated measurements with group and time as factors. Time-independent variables were compared with one-way analysis of variance.
No differences were found in any of the investigated parameters.
The present study suggests there are no differences in terms of cardiopulmonary performance, global oxygen transport, and regional hemodynamics when phenylephrine was administered instead of norepinephrine in the initial hemodynamic support of septic shock.
ClinicalTrial.gov NCT00639015.
先前的研究结果表明，在感染性休克患者中，用去氧肾上腺素替代去甲肾上腺素延迟给药会导致比去甲肾上腺素更明显的肝脾血管收缩。然而，尚未对这两种研究药物进行直接比较。因此，本研究的目的是调查在感染性休克患者中，一线使用去氧肾上腺素或去甲肾上腺素治疗对全身和局部血流动力学的影响。
我们在一家大学医院的多学科重症监护病房进行了一项前瞻性、随机、对照试验。我们纳入了尽管进行了充分的液体复苏但平均动脉压仍低于65 mmHg的感染性休克患者（n = 32）。患者被随机分配接受去甲肾上腺素或去氧肾上腺素输注治疗（每组n = 16），滴定剂量以达到平均动脉压在65至75 mmHg之间。在基线和12小时后获取右心导管检查、热稀释导管、胃张力测定、酸碱平衡以及肌酐清除率和心肌肌钙蛋白的数据。使用以组和时间为因素的重复测量双向方差分析来分析组内和组间的差异。将与时间无关的变量与单向方差分析进行比较。
在所研究的任何参数中均未发现差异。
本研究表明，在感染性休克的初始血流动力学支持中，用去氧肾上腺素替代去甲肾上腺素在心肺功能、整体氧输送和局部血流动力学方面没有差异。
ClinicalTrial.gov NCT00639015。
