Ognibene F P
Department of Critical Care Medicine, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Clin Chest Med. 1996 Jun;17(2):279-87. doi: 10.1016/s0272-5231(05)70314-2.
Hemodynamic support during sepsis should focus on aggressive resuscitation coupled with vasopressors aimed at restoration of blood pressure and end-organ perfusion and preservation. The choice of vasopressors should be based on the degree and persistence of peripheral vasodilatation as well as the degree of cardiac stimulation required. Norepinephrine can and should be used when dopamine fails to improve blood pressure and perfusion after adequate volume resuscitation. Dopamine's role of renovascular preservation remains controversial. Therapeutic strategies aimed at supranormal improvements in cardiac index or oxygen delivery have no documented effect in septic patients and should not be part of their therapy.
脓毒症期间的血流动力学支持应侧重于积极复苏，并联合使用血管升压药，以恢复血压和改善终末器官灌注及维持其功能。血管升压药的选择应基于外周血管扩张的程度和持续时间以及所需的心脏刺激程度。在充分的容量复苏后，如果多巴胺未能改善血压和灌注，就可以且应该使用去甲肾上腺素。多巴胺在肾血管保护方面的作用仍存在争议。旨在使心脏指数或氧输送超常改善的治疗策略，在脓毒症患者中并无已证实的效果，不应成为其治疗的一部分。
