Desjars P, Pinaud M, Bugnon D, Tasseau F
Service de Réanimation Médicale, Hôtel-Dieu, Centre Hospitalier Universitaire, Nantes, France.
Crit Care Med. 1989 May;17(5):426-9. doi: 10.1097/00003246-198905000-00010.
We investigated 25 patients (aged 20 to 70 yr) in septic shock with low systemic vascular resistance in order to assess the effects on renal function of prolonged (24 to 240 h) norepinephrine (NE) infusion (range 0.5 to 1.5 micrograms/kg.min). Two sets of renal function tests were made: a) control study before NE therapy after the initial intravascular loading and on dopamine infusion (mean dosage 14 +/- 2 micrograms/kg.min); b) in the last 24 h of NE infusion associated with dopamine (2 to 3 micrograms/kg.min). The following renal function tests were measured: urine flow rate, creatinine, osmolar and free water clearances, and fractional excretion of sodium (FENa). Data were collected only in 22 nonanuric patients: urine flow rate, creatinine, and osmolar clearance increased (p less than .001), and free water clearance (p less than .001) and FENa (p less than .02) decreased. These results suggest that NE (0.5 to 1.5 micrograms/kg.min) may be used in the treatment of human septic shock without deleterious renal effects.
我们研究了25例（年龄20至70岁）患有低全身血管阻力的感染性休克患者，以评估长时间（24至240小时）输注去甲肾上腺素（NE）（剂量范围0.5至1.5微克/千克·分钟）对肾功能的影响。进行了两组肾功能测试：a）在初始血管内负荷后且在多巴胺输注（平均剂量14±2微克/千克·分钟）期间，在NE治疗前进行对照研究；b）在与多巴胺（2至3微克/千克·分钟）联合使用的NE输注的最后24小时内。测量了以下肾功能测试指标：尿流率、肌酐、渗透清除率和自由水清除率，以及钠排泄分数（FENa）。仅在22例非无尿患者中收集数据：尿流率、肌酐和渗透清除率增加（p<0.001），自由水清除率（p<0.001）和FENa（p<0.02）降低。这些结果表明，NE（0.5至1.5微克/千克·分钟）可用于治疗人类感染性休克，而不会对肾脏产生有害影响。
