目的 探讨血管升压素(特利加压素terlipressin,TP)、多巴胺(dopamine,DA)在治疗脓毒性休克过程中对血流动力学及动脉氧合的影响.方法 选择2009-03~2011-05我院EICU收治的脓毒血症患者36例,按随机分原则分别给予TP(TP组)或DA(DA组)升压治疗,分别于治疗0、2、4、和6 h检测血流动力学指标[心率(HR)、平均动脉压(MAP)、心排血指数(CI)、每搏指数(SI)、体循环阻力指数(SVRI)、心脏加速指数(ACI)、左室做功指数(LCWI)、胸腔内液体水平(TFC)、心排血量(CO)、中心静脉压(CVP)、肺动脉压(PAP)、肺动脉嵌压(PAWP)等]、中心静脉血氧饱和度(ScvO2)、血乳酸(Lac)及每小时尿量(UV);于6 h末测定肌酐清除率(CCr).结果两组各时间点MAP、SI及TFC比较差异均无统计学意义;而LCWI治疗2 h末比较差异无统计学意义(P=0.031).DA组的HR、CI及ACI明显高于TP组,而SVRI明显低于TP组(P<0.05或P<0.01);两组给药后各时间点ScvO2比较差异无统计学意义(P均>0.05),而DA组Lac水平明显高于TP组(P均<0.05),TP组各时间点UV值显著高于DA组(P<0.05或P<0.01),TP组给药后6 h末SCr值显著高于DA组(P<0.01).结论 对于伴随快速型心律失常或组织缺氧严重的脓毒性休克患者TP可能是好的选择;TP用于合并急性肾功能不全的脓毒性休克患者,可改善预后,对于伴随少尿(或)肾功能损伤的脓毒性休克患者,在升血压治疗过程中如若产生DA剂量依赖,则选择TP可能更合理.%Objective To explore ihe effecls of vasopressin ( lerlipressin, TP) and dopamine (DA) on ihe hemodynamics and Lissue oxygenalion in ihe palienls wilh seplic shock. Methods 36 seplic shock palienls were divided randomly inlo TP group and DA group from March 2009 Lo May 2011 inEICU. The hemodynamic parameters(HR, MAP, CI, SI, SVRI, ACI, LCWI, TFC, CVP, PAP, PAWP, CO, ScvO2, Lac, UV ) were delecled al 0, 2, 4, and 6 hours after ihe Lrealmenl. CCr were delecled al 6 hour after ihe lrealmenl. Results MAP, SI and TFC had no difference belween Iwo groups al differenl limes. The LCWI had no difference belween Iwo groups al 2 h after ihe lrealmenl (P = 0. 031). HR, CI and ACI were significantly higher in the DA group lhan in the TP group. SVRI were significantly lower in the DA group lhan in the TP group ( P < 0. 05 or P < 0. 01) . There was no statistical difference in ScvO2 belween Iwo groups al differenl limes after the lrealmenl, but Lac level was higher in ihe DA group lhan in TP group (all P < 0. 05 ) , UV was higher in TP group al the differenl limes lhan in DA group ( P < 0. 05 or P < 0. 01) , and SCr was higher in TP group al 6 h after the lrealmenl lhan in DA group ( P < 0. 01). Conclusion TP may be good choice in the seplic shock palienls wilh lachyarrhylhmia or severe lissue hypoxia. TP may improve clinical outcome in the seplicshock palienls wilh acule renal dysfunclion. When seplic shock palienls wilh oliguria or renal injure had DA dependence, ihe TP may be more reasonable choice.
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