肾上腺素与多巴胺治疗儿童脓毒性休克疗效比较  

Comparative Study of Epinephrine and Dopamine in the Treatment of Children with Septic Shock

作　　者：朱金兰[1] 马伟科[1] 

机构地区：[1]深圳市儿童医院,广东深圳518038

出　　处：《儿科药学杂志》2016年第5期12-15,共4页Journal of Pediatric Pharmacy

摘　　要：目的:比较肾上腺素与多巴胺治疗儿童脓毒性休克的疗效。方法:采用前瞻性随机对照临床试验(RCT)研究方法,选择2013年2月至2015年2月入住我院PICU的严重脓毒症(脓毒性休克)患儿60例,随机分为多巴胺组和肾上腺素组各30例并应用相应药物进行治疗。多巴胺起始剂量7.0μg/(kg·min),如未达到治疗目标,每20 min增加2.5μg/(kg·min),最大剂量20.0μg/(kg·min);肾上腺素起始剂量0.1μg/(kg·min),每20 min增加0.1μg/(kg·min),最大剂量0.3μg/(kg·min)。比较两组患儿的血液动力学指标、氧代谢指标和病死率。结果:肾上腺素组平均动脉压(MAP)、射血分数(EF)、中心静脉血氧饱和度(Scv O2)、每小时尿量(UV)在用药后6 h、24 h均高于多巴胺组(P均<0.05)。两组患儿的心率(HR)、中心静脉压(CVP)在各时间点比较,差异均无统计学意义(P均>0.05)。肾上腺素组血清乳酸在用药后6 h高于多巴胺组(P<0.05);在用药后24 h时,与多巴胺组比较,差异无统计学意义(P>0.05)。肾上腺素组病死率(16.67%)低于多巴胺组(40.00%),差异有统计学意义(P<0.05)。结论:与多巴胺相比,肾上腺素能更有效纠正脓毒性休克患儿的血流动力学及氧代谢异常,早期应用能改善预后。Objective： To study the effect of epinephrine and dopamine in the treatment of children with septic shock. Methods： A prospective randomized controlled clinical trial （RCT） research was adopted. Sixty cases of children who were met the clinical criteria for septic shock in our hospital from February, 2013 to February, 2015 were selected and randomly divided into dopamine group and epinephrine group. The children in dopamine group were started on dopamine infusion at 7.0 μg,/（ kg min） with a dose increment of 2.5 μg/（ kg min） every 20 minutes, until the maximum dose 20.0 μg,/（ kg min） were achieved. The children in epinephrine group received epinephrine infusion started at a dose of 0.1 μg/（ kg min） with a dose increment of O. 1 μg/（ kg min） every 20 minutes, until the maximum dose 0.3 μg/（ kg min） were achieved. The hemodynamic indexes, oxygen metabolic parameters and mortality rates in two groups were compared. Results： After treatment in 6 hours and 24 hours, the mean arterial pressure （MAP） , ejection fraction （EF）, central venous oxygen satureation （ScvO2 ） and urine volume per h （UV） in epinephrine group were significantly higher than those in dopamine group （P〈0.05）. There were no significant differences in heart rate （HR） and central venous pressure （CVP） at different time points （P〉0.05）. Serum lactate was significantly higher in epinephrine group （P〈0.05） at 6 hours, there were no differences in both groups at 24 hours. The mortality rate was significantly lower in epinephrine group （P 〈 0.05 ）. Conclusion： Epinephrine was more useful in reversing the hemodynamic and metabolic abnormalities in septic shock compared with dopamine.

关 键 词：肾上腺素 多巴胺 脓毒性休克 血管活性药物 

分 类 号：R725.9[医药卫生—儿科]