Department of Nursing, VU University Medical Centre, Amsterdam, the Netherlands.
Am J Crit Care. 2013 Jan;22(1):22-32. doi: 10.4037/ajcc2013748.
Critically ill patients with circulatory shock sometimes need rescue treatment with high doses of norepinephrine, a treatment that may be associated with a poor outcome because of excessive vasoconstriction.
To evaluate the outcome of treatment and its determinants in patients with circulatory shock who received high doses of norepinephrine in the intensive care unit and to identify indicators of futility for the treatment.
A retrospective study was done on 113 consecutive patients with circulatory shock who received 0.9 μg/kg per minute or greater of norepinephrine during at least 1 hour at any time in the intensive care unit. Data were extracted from the electronic patient data management system according to a predefined checklist.
A total of 39 patients survived for 28 days after admission to the intensive care unit. The variables independently associated with 28-day mortality in multivariable models included low urine flow, high lactate levels, high organ failure score, high prothrombin time, and need for epinephrine cotreatment. The reason, dose, and duration of norepinephrine administration did not have prognostic significance. Scores greater than 40 on the Acute Physiology and Chronic Health Evaluation II, bicarbonate levels less than 9.0 mEq/L, or receipt of an epinephrine dose of 0.25 μg/kg per minute or greater were associated with 100% mortality.
Although the cause of shock and treatment with norepinephrine were not predictive of death when high doses of the drug were deemed necessary, rescue treatment with high-dose norepinephrine is futile in patients with severe disease and metabolic acidemia.
循环休克的危重症患者有时需要大剂量去甲肾上腺素进行抢救治疗，这种治疗可能会因过度血管收缩而导致预后不良。
评估在重症监护病房接受大剂量去甲肾上腺素治疗的循环休克患者的治疗结局及其决定因素，并确定治疗无效的指标。
对 113 例连续接受循环休克患者进行回顾性研究，这些患者在重症监护病房的任何时间至少接受 0.9 μg/kg/分钟或更高剂量的去甲肾上腺素治疗 1 小时以上。根据预定义的检查表，从电子患者数据管理系统中提取数据。
共有 39 例患者在入住重症监护病房后 28 天存活。多变量模型中与 28 天死亡率独立相关的变量包括尿量低、乳酸水平高、器官衰竭评分高、凝血酶原时间高以及需要肾上腺素联合治疗。去甲肾上腺素的给药原因、剂量和持续时间与预后无关。急性生理与慢性健康评估 II 评分大于 40、碳酸氢盐水平小于 9.0 mEq/L 或接受 0.25 μg/kg/分钟或更高剂量肾上腺素治疗与 100%死亡率相关。
虽然当需要大剂量药物时，休克的原因和去甲肾上腺素的治疗与死亡无关，但在严重疾病和代谢性酸中毒患者中，大剂量去甲肾上腺素的抢救治疗是无效的。
