Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
PLoS One. 2022 Nov 3;17(11):e0277087. doi: 10.1371/journal.pone.0277087. eCollection 2022.
Only a few observational studies using small patient samples and one subgroup analysis have compared norepinephrine and dopamine for the treatment of cardiogenic shock (CS). The objective of the present study was to investigate whether the use of norepinephrine was associated with improvements in clinical outcomes in CS patients compared to dopamine.
We retrospectively reviewed hospital medical records of patients who were admitted to cardiac intensive care unit from 2012 to 2018. We included 520 patients with CS in this analysis. The primary outcome was in-hospital mortality, and serial hemodynamic data were also assessed.
As a first-line vasopressor, dopamine was used in 156 patients (30%) and norepinephrine in 364 patients (70%). Overall, the norepinephrine group had significantly higher severity of shock, arrest at presentation, vital signs, and lactic acid than did the dopamine group at the time of vasopressor initiation. Nevertheless, in the norepinephrine group, additional vasopressor was required in 123 patients (33.8%), which was a significantly smaller percentage than the 92 patients (56.4%) in the dopamine group who required additional vasopressor (p < 0.001). There was no significant difference in in-hospital mortality between the two groups (26.9% and 31.9%, respectively, p = 0.26). In addition, the incidence of arrhythmia was not different between the two groups (atrial fibrillation, 12.2% vs. 15.7%, p = 0.30; ventricular tachyarrhythmia, 19.9% vs. 25.3%, p = 0.18).
The use of norepinephrine as a first-line vasopressor was not associated with reductions of in-hospital mortality or arrythmia but could reduce use of additional vasopressors in CS patients.
仅有少数几项观察性研究使用小样本患者和一个亚组分析比较了去甲肾上腺素和多巴胺在治疗心源性休克（CS）方面的疗效。本研究的目的是探讨与多巴胺相比，使用去甲肾上腺素是否与 CS 患者的临床转归改善相关。
我们回顾性分析了 2012 年至 2018 年期间入住心脏重症监护病房的患者的住院病历。本分析纳入了 520 例 CS 患者。主要结局为住院死亡率，还评估了连续的血流动力学数据。
作为一线血管加压药，多巴胺用于 156 例（30%）患者，去甲肾上腺素用于 364 例（70%）患者。总体而言，与多巴胺组相比，去甲肾上腺素组在开始使用血管加压药时休克严重程度、心搏骤停、生命体征和乳酸水平显著更高。然而，在去甲肾上腺素组中，有 123 例（33.8%）患者需要额外的血管加压药，这一比例显著低于多巴胺组的 92 例（56.4%）患者（p<0.001）。两组的住院死亡率无显著差异（分别为 26.9%和 31.9%，p=0.26）。此外，两组的心律失常发生率也无差异（心房颤动，12.2% vs. 15.7%，p=0.30；室性心动过速，19.9% vs. 25.3%，p=0.18）。
将去甲肾上腺素作为一线血管加压药使用与降低住院死亡率或心律失常无关，但可能减少 CS 患者额外使用血管加压药的需求。
