Dasta J F
Ohio State University, College of Pharmacy, Columbus 43210.
DICP. 1990 Feb;24(2):153-6. doi: 10.1177/106002809002400208.
Vasopressors are the mainstay after fluids in the hemodynamic support of patients with septic shock. Although dopamine is commonly used in this situation, it is sometimes ineffective. Because of its potential adverse vasoconstrictive effects, norepinephrine usually has been chosen only when all other drugs have failed in septic shock. However, several recent reports have suggested a beneficial effect of norepinephrine, often in doses higher than those commonly used. Specifically, these studies in 77 patients showed that norepinephrine effectively elevates blood pressure and increases systemic vascular resistance without decreasing cardiac output. Renal function in these patients appears to be maintained. Information on oxygen transport is variable; however, the mortality from sepsis remains high at between 17 and 50 percent. Until more information becomes available, norepinephrine appears to be a useful drug in maintaining blood pressure in patients with septic shock, but higher than usual doses may be needed.
血管活性药物是感染性休克患者液体复苏后血流动力学支持的主要手段。虽然多巴胺常用于这种情况，但有时效果不佳。由于其潜在的不良血管收缩作用，去甲肾上腺素通常仅在感染性休克中所有其他药物均无效时才会被选用。然而，最近的几份报告表明，去甲肾上腺素通常在高于常用剂量时具有有益作用。具体而言，这些针对77例患者的研究表明，去甲肾上腺素可有效升高血压并增加全身血管阻力，而不降低心输出量。这些患者的肾功能似乎得以维持。关于氧输送的信息各不相同；然而，脓毒症的死亡率仍然很高，在17%至50%之间。在获得更多信息之前，去甲肾上腺素似乎是维持感染性休克患者血压的一种有用药物，但可能需要高于常用的剂量。
