Comparison of norepinephrine-dobutamine to dopamine alone for splanchnic perfusion in sheep with septic shock  

去甲肾上腺素和多巴酚丁胺联用与多巴胺单用对感染性休克绵羊内脏灌流的比较

作　　者：杨毅[1] 邱海波[1] 周韶霞[1] 谭焰[1] 李书清 

机构地区：[1]东南大学医学院附属中大医院危重病医学科,南京中国210009

出　　处：《Acta Pharmacologica Sinica》2002年第2期133-137,共5页中国药理学报（英文版）

摘　　要：splanchnic perfusion.To compare the effect of norepinephrine-dobu-tamine with dopamine alone on splanchnic perfusion in sheep with septic shock. METHODS: Twenty sheep with septic shock induced by lipopolysaccharides were divided into two groups. When systolic pressure decreased by 5.3 kPa, basic values of hemodynamic parameters and intestinal intramucosal pH (pHi) were recorded. Each group was randomized to receive an intravenous infusion of norepinephrine-dobutamine or dopamine, and titrated to obtain mean arterial pressure (MAP) > 12 kPa with an optimal cardiac preload. Hemodynamic parameters and mucosal pHi were repeated at 1, 2, 3, and 4 h after basic measurement. RESULTS: After norepinephrine-dobutamine or dopamine infusion, MAP, cardiac output, and oxygen delivery increased in all animals compared with basic values in both groups ( P < 0.05). Compared with baseline values, lactate concentrations decreased at 3 h and 4 h [from (4±2) mmol/L to (2±1) mmol/L in the norepinephrine-dobutamine group ( P < 0.05 ). Arterial lactate concentrations had no change in dopamine group, but arterial pH decreased from 7. 40±0. 05 to 7.26±0.06 at 1 h ( P <0.05 ). No difference in pHi was found in dopamine group, but in the norepinephrine-dobutamine group, compared with baseline, pHi increased from 7. 19±0. 04 to 7. 36±0. 07 at 3 h (P<0.05). CONCLUSION: Both norepinephrine-dobutamine and dopamine alone could improve systemic hemodynamics in sheep with septic shock, but norepinephrine-dobutamine was better than dopamine on splanchinc perfusion目的:观察多巴酚丁胺加去甲肾上腺素和单用多巴胺对感染性休克绵羊内脏灌注的影响.方法:利用内毒素(LPS)复制感染性休克模型,当收缩压下降至5.3kPa时记录血流动力学及肠粘膜pH(pH_i)的基础值.20只绵羊随机分为两组,分别静脉注入多巴酚丁胺加去甲肾上腺素及多巴胺,调整药物剂量,使平均动脉压升高到12kPa,观察用药前(基础值)及用药后1,2,3,4h的血流动力学和内脏灌注指标pH_i.结果:两组动物在用药后血压、心排指数及氧输送较用药前明显升高。多巴胺组动脉乳酸浓度及pH_i无明显改变,但动脉pH值在用药后1h从7.40±0.05降至7.26±0.06(P<0.05).应用多巴酚丁胺加去甲肾上腺素后3h和4h,动脉乳酸浓度从(4±2)mmol/L降至(2±1)mmol/L和(2±1)mmol/L(P<0.05),用药后3h,pH_i从7.19±0.04明显升高到7.36±0.07(P<0.05).结论:多巴酚丁胺加去甲肾上腺素和单用多巴胺均能改善感染性休克绵羊全身血流动力学状态,但在改善内脏灌注上,多巴酚丁胺与去甲肾上腺素联用明显优于多巴胺单用.

关 键 词：septic shock NOREPINEPHRINE dobu-tamine DOPAMINE TONOMETRY splanchnic circulation LACTATES HEMODYNAMICS 

分 类 号：R96[医药卫生—药理学]