Service de réanimation polyvalente, Hôpital Antoine Béclfère, Hôpitaux universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Clamart, France.
Service de réanimation médicale, Hôpital Bicêtre, Hôpitaux universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
Br J Anaesth. 2018 Mar;120(3):517-524. doi: 10.1016/j.bja.2017.11.065. Epub 2017 Nov 21.
We conducted this study to investigate whether norepinephrine increases cardiac contractility when administered during the early phase of septic shock.
We studied 38 patients with septic shock who had been resuscitated for <3 h and whose mean arterial pressure (MAP) remained <65 mm Hg. Echocardiographic variables were obtained before (T) and after either initiation or an increase in the dose of a norepinephrine infusion to increase MAP to ≥ 65 mm Hg (T). We collected left ventricular ejection fraction (LVEF), velocity-time integral of the left ventricular outflow tract (VTI), tissue Doppler imaging of mean systolic velocity of the lateral tricuspid annulus (S) and of the lateral mitral annulus (S), and tricuspid annular plane systolic excursion (TAPSE).
There were significant (P<0.05) increases from T to T in MAP [mean (sd): from 56 (7) to 80 (9) mm Hg], LVEF [from 49 (13) to 56 (13)%], VTI [from 18 (5) to 20 (6) cm], S [from 10.8 (5.1) to 12.1 (5.0) cm s], TAPSE [from 1.8 (0.5) to 2.0 (0.5) cm], and S [from 13.0 (5.6) to 15.1 (6.4) cm s]. In the subgroup of 15 patients with LVEF ≤45%, significant increases in VTI [from 16 (8) to 18 (7) cm] and in LVEF [from 36 (7) to 44 (10)%] were observed.
Norepinephrine administration during early resuscitation in patients with septic shock increased the cardiac systolic function despite the presumed increase in left ventricular afterload secondary to the increased arterial pressure. Whether such an effect persists over time remains to be evaluated.
NCT02750683.
我们进行这项研究旨在探讨去甲肾上腺素在脓毒性休克早期应用时是否会增加心肌收缩力。
我们研究了 38 例复苏时间 <3 小时且平均动脉压（MAP）仍 <65mmHg 的脓毒性休克患者。在开始或增加去甲肾上腺素输注以将 MAP 增加至 ≥65mmHg（T）之前（T）和之后，获得超声心动图变量。我们收集左心室射血分数（LVEF）、左心室流出道速度时间积分（VTI）、外侧三尖瓣环（S）和外侧二尖瓣环（S）的组织多普勒成像平均收缩速度以及三尖瓣环平面收缩位移（TAPSE）。
MAP 从 T 到 T 显著增加（P<0.05）[平均值（标准差）：从 56（7）增加到 80（9）mmHg]，LVEF [从 49（13）增加到 56（13）%]，VTI [从 18（5）增加到 20（6）cm]，S [从 10.8（5.1）增加到 12.1（5.0）cm/s]，TAPSE [从 1.8（0.5）增加到 2.0（0.5）cm]，S [从 13.0（5.6）增加到 15.1（6.4）cm/s]。在 LVEF≤45%的 15 例患者亚组中，VTI [从 16（8）增加到 18（7）cm]和 LVEF [从 36（7）增加到 44（10）%]显著增加。
尽管 MAP 升高导致左心室后负荷增加，但在脓毒性休克患者早期复苏期间给予去甲肾上腺素增加了心脏收缩功能。这种作用是否随时间持续存在仍有待评估。
NCT02750683。
