心源性休克儿茶酚胺类药物的选择与应用  

The choice and application of catecholamines in cardiogenic shock

作　　者：郑昭芬[1,2,3] 唐毅 潘宏伟 何晋[1,2,4] Zheng zhaofen;Tang Yi;Pan Hongwei;He Jin(Department of Cardiology,Hunan Provincial People’s Hospital(The First Affiliated Hospital of Hunan Normal University;Key Laboratory of Heart Failure of Hunan Normal University;Hunan Provincial Institute of Emergency Medicine,Hunan Provincial Key Laboratory of Emergency and Critical Care Metabonomics;Hunan Provincial Clinical Research Center of Clinical Intervention)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)心血管内科 [2]湖南师范大学心力衰竭重点实验室 [3]湖南省急救医学研究所急危重症代谢组学湖南省重点实验室 [4]湖南省临床介入临床医学研究中心

出　　处：《实用休克杂志（中英文）》2020年第1期10-13,共4页Journal of Practical Shock

基　　金：湖南省科技厅重点领域研发计划(项目编号:2019SK2021)。

摘　　要：儿茶酚胺类药物是稳定心源性休克血流动力学的基础用药,该类药物应用需个体化。收缩压维持于80~90mmHg,可先用多巴酚丁胺或多巴胺;收缩压<80mmHg或平均动脉压<60mmHg,需要在提高心输出量的同时进一步收缩血管提升血压时,可首选去甲肾上腺素;较大剂量单药不能维持血压时,尽早联合用药,可以选用多巴酚丁胺联合去甲肾上腺素、多巴胺联合去甲肾上腺素、多巴酚丁胺联合多巴胺;过大剂量多巴胺(≥15μg·kg^-1·min^-1)副作用多,近期死亡增加,应尽量避免。Catecholamines is the basic drugs to maintain the stability of hemodynamics in cardiogenic shock,but these drugs should be used according to the condition of each patient.When systolic blood pressure is 80~90 mmHg,dobutamine or dopamine should be the first choice;when the systolic blood pressure is less than 80 mmHg or mean arterial pressure less than 60 mmHg,it is important that contracting peripheral blood vessels to increase blood pressure ought to be considered on the top of using drugs to increase cardiac output,norepinephrine should be the first choice;when one drug at high dose can not maintain the stability of hemodynamics,two drugs in combination should be used as soon as possible,such as dobutamine combined with norepinephrine,dopamine combined with norepinephrine,dobutamine combined with dopamine;high dose of dopamine(≥15μg·kg^-1·min^-1)has much side effects,increase the risk of recent death,therefore high dose of dopamine should be avoided.

关 键 词：心源性休克 儿茶酚胺类药物 治疗 

分 类 号：R541.64[医药卫生—心血管疾病]