近红外光检测多巴胺及去甲肾上腺素对脓毒性休克患者组织氧合的影响  

Effect of dopamine and norepinephrine on tissue oxygenation with near infrared spectroscopy in patients with septic shock

作　　者：吴丽娟[1] 何权瀛[1] 李刚[2] 尹培刚[2] 陈德生[2] 易丽[2] 黄絮[2] 段军[2] 

机构地区：[1]北京大学人民医院呼吸科,北京100044 [2]中日友好医院ICU,北京100029

出　　处：《中日友好医院学报》2008年第5期259-262,共4页Journal of China-Japan Friendship Hospital

摘　　要：目的:应用近红外光(NIRS)及血乳酸测定等手段探讨多巴胺(DA)及去甲肾上腺素(NE)对脓毒性休克患者全身及局部器官组织氧合的影响。方法:16例脓毒性休克患者按照随机分组平行交叉的方法给予DA和NE治疗,各组观察时间为4h,分别于各小时末检测脑及肝脏组织的氧合及灌注指标:氧合血红蛋白变化(△HbO2)、还原血红蛋白变化(△Hb)、组织血氧饱和度(StO2)、血容量变化(△BV)及组织灌注的变化(△HbD),检测平均动脉压(MAP),中心静脉血氧饱和度(ScvO2)及血乳酸,比较两组间上述指标的差别。结果:(1)DA组患者脑组织的StO2、△HbD及△BV均较NE组显著升高(P<0.05,P<0.01)。(2)NE组患者肝脏组织的△HbD及△BV均显著高于DA组(P<0.05,P<0.01),在第3、4h末NE组的StO2也显著高于DA组(均P<0.01)。(3)两组的ScvO2在各时间点比较,差异均无显著性意义(均P>0.05),而NE组的血乳酸水平显著低于DA组(均P<0.05)。(4)DA组与NE组的MAP无显著性差异(P>0.05)。结论:DA比较有利于脑组织的灌注及氧合,而NE更有利于肝脏的灌注及氧合;在改善全身组织的灌注及氧合作用方面,NE略好于DA。Objective：To explore the effects of dopamine（DA）and norepinephrine（NE）on tissue oxygenation in patients with septic shock.Methods：Sixteen patients with septic shock were assigned to the groups of DA and NE randomly.They were given DA or NE for four hours,then shifted to NE or DA.Indexes of oxygenation and perfusion （△HbO2, △Hb,StO2, △HbD, △BV）for cerebral and liver tissue were recorded with NIRS （near infrared spectroscopy）at the end of the 1 st,2nd,3rd,4th hour.Mean artery pressure（MAP）,central venous oxygen saturation （Scvo2） and venous lactate were measured at the end of the 1st,2nd,3rd,4th hour for each of the two drugs.The differences of all parameters between the two groups were compared.Results：（1）StO2, △HbD, △BV of cerebral tissue at the end of each hour in DA group were significantly higher than those in NE group（P〈0.05,P〈0.01）.（2）△HbD and △BV of liver tissue at the end of each hour in NE group were significantly higher than those in DA group （P〈0.05,P〈0.01）.StO2 of liver tissue in NE group was also higer than it in DA group at the end of the 3rd,4th hour （P〈0.01）.（3）There was no difference for MAP and ScvO2 between the two groups （P〉0.05）.（4）Lactate in the group of NE were significantly lower than it in DA group （P〈0.05）.Conclusion：DA may have a better effect than NE in increasing the oxygenation and peffusion for cerebral tissue,and NE may have a better effect in improving the oxygenation and perfusion for liver tissue. NE may be better than DA for improving whole body tissue oxygenation.

关 键 词：近红外光 脓毒性休克 多巴胺 去甲肾上腺素 组织氧合 

分 类 号：R459.7[医药卫生—急诊医学]