不同血管活性药物对脓毒症休克患者血乳酸的影响  

Different vascular active drug blood lactic acid in patients with sepsis shock

作　　者：王玉巧 杨海荣 刘亮 张跃斌 

机构地区：[1]宁夏人民医院ICU科,宁夏银川750002

出　　处：《宁夏医学杂志》2015年第6期534-536,共3页Ningxia Medical Journal

基　　金：宁夏自然科学基金资助项目(NZ1256)

摘　　要：目的探讨脓毒症休克患者用不同血管活性药物时血流动力学及血乳酸浓度的变化及其意义。方法符合入选标准的40例脓毒症休克患者,采用随机数字表法分为多巴胺组(DA)20例和去甲肾上腺素组(NE)20例,观察患者血流动力学指标、血乳酸、乳酸清除率及病死率。结果治疗6、12、24及48 h后,NE组的HR明显低于DA组;2组患者治疗前后各时点MAP水平比较,差异无统计学意义(P>0.05);治疗6、12、24及48 h后NE组较DA组尿量有所增加;治疗12、24及48 h后NE组Sc VO2有所升高;治疗12、24及48 h后NE组血乳酸低于DA组;治疗12、24及48 h后乳酸清除率较DA组增加;DA组病死率35%,NE组病死率25%。结论对脓毒性休克患者,NE与DA均能有效维持脓毒症休克患者血流动力学稳定,NE较DA能更好地维持血流动力学稳和提升血压,更有效地降低乳酸,提高乳酸清除率,从而降低患者的病死率。Objective To explore the sepsis shock patients with different vascular active drugs hemodynamics and blood lactic acid concentration changes and its significance. Methods 40 cases of patients with sepsis shock were randomly divided into Dopamine group （ DA, n = 20） and Norepinephrine group （ Norepinephrine NE, n = 20 ）, and the hemodynamic indexes, blood lactic acid, lactic acid clearance rate and case fatality rate were observed. Results HR was obviously lower in NE group than that in DA group at 6,12,24 h and 48h. The MAP had no statistical significance of patients before and after treatment between two groups （ P 〉 0.05 ） ; Urine volume was in- creased treatment after NE at 6,12,24 h and 48h in DA group;ScVO2 was increased after treatment in group NE at 12,24 h and 48 h; Blood lactic acid was lower treatment NE than that in DA group at 12,24 h and 48 h;Lactate clearance rate was higher in DA group than that in NE group at 12,24 h and 48 h after treatment;Case fatality rate was 35% in DA group and was 25% in NE group. Conclusion NE and DA can effectively maintain stable hemodynamics in patients with sepsis shock ,and NE can be better to maintain hemodynamic stabili- ty,increase blood pressure ,effectively reduce lactic acid and improve lactate clearance rate. So as to reduce the mortality of patients.

关 键 词：脓毒性休克 乳酸 去甲肾上腺素 多巴胺 

分 类 号：R459.7[医药卫生—急诊医学]