去甲肾上腺素对感染性休克患者肾脏功能的影响  

Effect of norepinephrine on renal function in the patients with septic shock

作　　者：侯立朝[1] 熊利泽[1] 陈绍洋[1] 计根林[1] 王雅丽[1] 陈敏[1] 

机构地区：[1]西安市第四军医大学附属西京医院麻醉科,710032

出　　处：《临床麻醉学杂志》2007年第2期144-146,共3页Journal of Clinical Anesthesiology

基　　金：国家自然科学基金资助课题(No30672041;No30471675);陕西省科技攻关课题(No2004K17-G15)

摘　　要：目的观察去甲肾上腺素（NE）对感染性休克患者肾脏功能的影响。方法收集在ICU接受治疗的感染性休克患者65例。根据临床实际使用NE的最大泵注速率，将患者分成A组（n=21）、B组（n=22）和C组（n=22）。三组NE最大泵注速率分别为0．01-0．1、0．1-0．5和≥0．5μg·kg·min^-1。在治疗前对所有休克患者进行急性生理学与慢性健康状况评分系统（APACHEⅢ）评分，记录其BP、HR变化及尿量、血尿素氮（BUN）和肌酐（CRE）、尿白蛋白（ALB）和β2-微球蛋白（β2-MG）定量等肾功能指标变化。结果抗休克治疗前，B组患者的APACHE Ⅲ评分明显高于A组，但低于C组（P〈0．05）；所有患者BUN、CRE、尿ALB和β2-MG定量均异常升高，但组阃差异无统计学意义。抗休克治疗开始后，与治疗前相比，患者尿量（UO）、BUN和CRE、尿ALB和172-MG定量逐步恢复，但组间差异无统计学意义。结论NE用于感染性休克时，患者肾脏功能的恢复与血流动力学的稳定相关，而与其剂量的关系不大。Objective To observe the effect of norepinephrine（NE） on the renal function in the patients with septic shock. Methods Sixty-five patients with septic shock were studied in this article. And based on the highest clinical infusing rate of NE,the patients were divided into group A（n： 21）, group B（n=22） and group C（n=22） with the highest infusing rate of NE at 0. 01-0.1, 0.1-0. 5 and≥ 0.5μg·kg·min^-1,respectively. APACHE Ⅲ score and the changes in arterial blood pressure, heart rate （ HR）, urinary output, blood urea nitrogen （BUN）, creatinine （CRE）, urinary albumin （ALB） and β2-microglobulin （β2-MG） were recorded. Results Before anti-shock therapy,APACHE Ⅲ scoring in group B was higher than that in group A,but lower than that in group C （P〈0.01）. The abnormally increased level of BUN,CRE, urine ALB and β2-MG output occurred in all patients before anti-shock therapy,which were not statistically different among the three groups. During antishock therapy, urine output, BUN, CRE, urine ALB and β2-MG output gradually decreased. Conclusion NE in the patients with septic shock could promote the restoration of the abnormal renal function,which seemed to be not related to its dose,but mainly based upon the hemodynamic stability.

关 键 词：去甲肾上腺素 感染性休克 肾脏功能 

分 类 号：R459.7[医药卫生—急诊医学]