Agrawal Avinash, Gupta Alok, Consul Shuchi, Shastri Prakash
Department of Internal Medicine, Chattrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
Saudi J Anaesth. 2011 Apr;5(2):162-6. doi: 10.4103/1658-354X.82784.
The objective was to compare the ability of norepinephrine and dopamine in reversing the hemodynamic and metabolic abnormalities of septic shock using Edwards Vigileo Monitor with Flotrac Sensor.
Prospective randomized control study.
Fifty consecutive patients presenting with hyperdynamic septic shock who fulfilled the inclusion criteria were randomly allocated to either group I or group II. The goal of therapy was to achieve and maintain for 6 hours, all of the following - systolic blood pressure (SBP) >90 mmHg, systemic vascular resistance index (SVRI) >1800 dynes.s/cm(5)m(2), cardiac index (CI) >4.0 lt/min/m(2), index of oxygen delivery >550 ml/min/m(2), index of oxygen uptake >150 ml/min/m(2). The patients in group I were started on dopamine infusion at 10 μg/kg/min which was increased by 2.5 μg/kg/min, every 15 minutes till the goals were achieved. The patients in group II received norepinephrine infusion started at a dose of 0.5 μg/kg/min with a dose increment of 0.25 μg/kg/min, every 15 minutes till the goals were achieved.
Post-treatment heart rate showed an increase in the mean value in group I patients and a decrease in group II patients. The post-treatment mean SBP and SVRI in group II was significantly higher than that in group I. Patients in group I showed a significantly higher increase in post-treatment CI and index of oxygen delivery compared to patients in group II. Nineteen out of 25 patients responded to the treatment in group II while only 10 out of 25 responded in group I.
Norepinephrine was more useful in reversing the hemodynamic and metabolic abnormalities of hyperdynamic septic shock compared to dopamine.
使用爱德华兹Vigileo监护仪和Flotrac传感器比较去甲肾上腺素和多巴胺逆转感染性休克血流动力学和代谢异常的能力。
前瞻性随机对照研究。
连续入选50例符合纳入标准的高动力型感染性休克患者，随机分为I组或II组。治疗目标是达到并维持6小时以下指标——收缩压（SBP）>90 mmHg、全身血管阻力指数（SVRI）>1800达因·秒/厘米⁵·米²、心脏指数（CI）>4.0升/分钟/米²、氧输送指数>550毫升/分钟/米²、氧摄取指数>150毫升/分钟/米²。I组患者开始以10μg/kg/分钟的速度静脉输注多巴胺，每15分钟增加2.5μg/kg/分钟，直至达到目标。II组患者接受去甲肾上腺素静脉输注，起始剂量为0.5μg/kg/分钟，每15分钟剂量增加0.25μg/kg/分钟，直至达到目标。
治疗后，I组患者心率平均值升高，II组患者心率平均值降低。II组治疗后的平均SBP和SVRI显著高于I组。与II组患者相比，I组患者治疗后的CI和氧输送指数升高更为显著。II组25例患者中有19例对治疗有反应，而I组25例中只有10例有反应。
与多巴胺相比，去甲肾上腺素在逆转高动力型感染性休克的血流动力学和代谢异常方面更有效。
