老年感染性休克患者液体复苏后多巴酚丁胺的治疗作用及评价指标研究  

Efficacy of dobutamine for elderly patients with septic shock after initial fluid resuscitation

作　　者：宋佳[1] 龚仕金[2] 周娟娣[3] 严静[2] 李莉[2] 王敏佳[2] 胡伟航[4] 贾圣伟 

机构地区：[1]浙江中医药大学第二临床医学院,杭州310053 [2]浙江医院重症医学科 [3]浙江医院外科 [4]杭州市第一人民医院重症医学科

出　　处：《浙江医学》2015年第18期1529-1531,1553,共4页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2012KYA007);浙江省"十二五"基层卫生适宜技术成果转化工程重大项目(2013T01-13)

摘　　要：目的探讨老年感染性休克患者初步液体复苏后,采用心功能指数(CFI)评估多巴酚丁胺对患者血管外肺水指数(EVLWI)、组织灌注及氧代谢的影响。方法选择ICU中感染性休克患者60例,均置入PiCCO导管,接受初步液体复苏后GEDVI≥680 ml/m^2且SVV<10%,应用多巴酚丁胺并于6h后根据CFI将患者分为CFI达标组32例(CFI≥4.1)和CFI未达标组28例(CFI<4.1),分别记录应用多巴酚丁胺前及6h后两组患者的心率、收缩压、舒张压、平均动脉压(MAP)、中心静脉压(CVP)、心指数(CI)、全心舒张末容积指数(GEDVI)、EVLWI、CFI、全心射血分数(GEF)血流动力学参数;记录乳酸、乳酸清除率、氧合指数(PO_2/FiO_2)、中心静脉血氧饱和度(ScvO_2)等全身灌注及氧代谢指标。结果达标组患者CI、CFI、GEF:较治疗前明显升高,GEDVI、EVLWI较治疗前明显降低(均P<0.05)。与未达标组用药6h后相比,达标组患者CI、CFI、GEF升高更明显(均P<0.05),EVLWI下降更明显(P<0.05)。两组患者治疗后乳酸水平均逐渐下降,达标组较未达标组患者乳酸降低更明显(P<0 05),乳酸清除率更高(P<0.05)。治疗后,达标组较未达标组ScvO_2达标(即ScvO_2≥70%)的例数更多(P<0.05)。结论经过初步液体复苏后GEDVI≥680ml/m^2且SVV<10%的老年感染性休克患者应用多巴酚丁胺优化心脏收缩功能,CFI≥4.1时患者EVLWI明显降低、组织灌注及氧代谢水平得到改善。Objective TO evaluate the efficacy of dobutamine in elderly patients with septic shock after initial fluid resuscitation. Methods All patients received an initial fluid resuscitation, in whom the global end-diastolic volume index（GEDVI） was ≥680ml/m^2 and stroke volume variation （SVV） was 〈10%. Dobutamine was used to adjust the patient＇s cardiac systolic function, 6h after medication patients were classified as target CFI-achieved （CFI 〉14.1） or target CFI-not achieved （CFI 〈4.1） groups. The hemodynamic parameter including heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure（MAP）, central venous pressure（CVP）, cardiac index （CI）, GEDVI, extravascular lung water index（EVLWI）, cardiac function index （CFI）, global ejection fraction （GEF） and the tissue perfusion and oxygen metabolism parameters including lactate, lactate clearance, oxygenation index （POJFiO2）, central venous oxygen saturation （ScvO2） were measured in both groups before and 6h after application of dobutamine. Results After treatment, the CI, CFI, GEF was significantly increased, and GEDVI, EVLWI significantly decreased in target CFI-achieved group （P〈0.05）. CI, CFI, GEF in target CFI-achieved group was significantly higher and EVLWI was lower than those in target CFI-not achieved group （both P〈0.05）. Lactate was gradually reduced after treatment in both groups. Lactate in target CFI-achieved group decreased significantly compared with target CFI-not achieved group （P〈 0.05）, and lactate clearance increased significantly （P〈0.05）. After treatment, there were more patients with ScvO2≥ 70% in target CFl-achieved group than those in target CFI-not achieved group （P〈0.05）. Conclusion Dobutamin can decrease EVLWl, improve perfusion and oxygen metabolism in elderly patients with septic shock patients after an initial fluid resuscitation.

关 键 词：心功能指数 脉搏指示剂连续心排血量 感染性休克 多巴酚丁胺老年 

分 类 号：R459.7[医药卫生—急诊医学]