不同动脉压水平对老年感染性休克患者血流动力学组织灌注和代谢的影响  

Effects of different mean arterial pressure levels on hemodynamics, tissue perfusion and oxygen metabolism in elderly patients with septic shock

作　　者：李茂琴 许继元 李家琼 许艳军 莫逊 卢飞 李琳 张舟 李松梅 王惠敏 

机构地区：[1]江苏省徐州市中心医院ICU室 暨东南大学医学院附属徐州医院ICU室,221009

出　　处：《中华老年医学杂志》2008年第11期821-823,共3页Chinese Journal of Geriatrics

基　　金：基金项目：江苏省徐州市卫生局科研基金（2000917）

摘　　要：目的观察应用去甲肾上腺素联合多巴酚丁胺（NE＋Dobu）在不同平均动脉压（MAP）水平对老年感染性休克患者血流动力学、组织灌注和代谢的影响。方法感染性休克患者18例，充分液体复苏后为基础状态，应用NE＋Dobu并随机调节剂量，使MAP分别维持在65、75、85mm Hg3种水平状态，持续4h，观察不同MAP水平的血流动力学、氧合指标、血乳酸、肾功能和胃黏膜二氧化碳分压变化。结果当MAP达75mm Hg和85mm Hg时，心脏指数（4．7±0．6和5．1±0．7）、体循环阻力指数（1162±278和1276±319）、氧输送[（697±53）ml·min^-1·m^-2和（711±68）ml·min^-1·m^-2]、氧摄取率[（0．28±0．02）％和（0．27±0．02）%]，均较MAP为65mmHg时[4．0±0．6、1011±225、（634±70）ml·min^-1·m^-2、（0．25±0．02）％]明显增加（P〈0．05）；尿量分别为（98±43）ml／h和（91±54）ml／h，较65mm Hg时（74±49）ml／h有明显增加，但仅MAP75mmHg时，差异有统计学意义（P〈0．05）。结论老年感染性休克患者充分液体复苏后，应用NE＋Dobu提高MAP达75mm Hg时，可改善全身血流动力学和肾功能，对于老年感染性休克患者可能需要适当提高MAP。Objective To observe the effects of norepinephrine and dobutamine （NE＋Dobu） on hemodynamics, tissue perfusion and oxygen metabolism in elderly patients with septic shock at different levels of mean arterial pressure （MAP）. Methods After aggressive fluid resuscitation, norepinephrine and dobutamine were administered in 18 elderly patients with septic shock to correct hypotension. The rate of dobutamine infusion was 5 ug· kg^-1· min^- 1. Norepinephrine was titrated to maintain MAP at levels of 65 mm Hg , 75 mm Hg and 85 mmHg. Four hours later, the changes of hemodynamics, oxygenation index, blood lactate, renal function and gastric pCO2 at every MAP level were observed. Results There were no significant differences in heart rate （HR）, pulmonary arterial wedge pressure （PAWP）, volume of oxygen （VO2）, Blood lactate, pH value, △pCO2 and creatinine clearance rate （CCr） among the MAP levels of 65 mm Hg, 75 mm Hg and 85 mm Hg （ all P〉0.05）. Compared with MAP 65 mm Hg, cardiac index （CI）, systemic vascular resistance index （SVRI）, oxygen delivery over oxygen extraction ratio were obviously higher at MAP 75 mm Hg and 85 mm Hg [4.7±0.6, 5.1±0.7 vs. 4.0±0.6; 1162±278, 1276±319 vs. 1011±225;（697±53） ml·min^-1·m^-2,（711±68）ml·min^-1·m^-2 vs. （634±70） ml·min^-1·m^-2 （0.28±0.02）%, （0.27±0.02） % vs. （0.25±0.02） %, respectively, all P〈0. 051. The urinary output at MAP levels of 65 mm Hg, 75 mm Hg and 85 mm Hg were （98 ± 43） ml/h, （91 ± 54） ml/h and（74 ± 49） ml/h repectively, and only the differences between MAP 75 mm Hg and MAP 65 mm Hg had statistical significance （P〈0.05）. Conclusions After aggressive fluid resuscitation, hemodynamics and renal function are improved at MAP 75 mm Hg after administration of norepinephrine and dobutamine in elderly patients with septic shock. It should he considered that MAP is appropriately increased in elderly patients with septic shock.

关 键 词：休克 脓毒性 血压 胃黏膜 去甲肾上腺素 多巴酚丁胺 

分 类 号：R686[医药卫生—骨科学]