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目的:比较右美托咪定（DEX）与咪达唑仑对脓毒性休克患者内源性血浆儿茶酚胺水平以及维持血压的外源性去甲肾上腺素（NE）用量的影响。方法:纳入2018年1月至2019年12月贵州医科大学附属医院重症医学科收治的需要有创机械通气且重症监护病房（ICU）住院时间≥48 h的接受DEX或咪达唑仑镇静的脓毒性休克患者。动态记录患者入ICU 0、12、24、48、72 h血流动力学数据、动脉血乳酸（Lac）水平、动脉血气分析及血管活性药物用量；记录入ICU 0、24、48 h血浆儿茶酚胺水平，入ICU时急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）和序贯器官衰竭评分（SOFA），以及预后指标。结果:共纳入24例患者，DEX组及咪达唑仑组各12例。两组心率（HR）、中心静脉压（CVP）、静脉-动脉血二氧化碳分压差（Pv-aCOn 2）、氧合指数（PaOn 2/FiOn 2）、Lac水平均存在相似的动态变化趋势，DEX组12 h时CVP和72 h时Pv-aCOn 2明显高于咪达唑仑组〔CVP（mmHg，1 mmHg＝0.133 kPa）：13±3比10±3，Pv-aCOn 2（mmHg）：9.4±5.2比4.8±2.2，均n P0.05〕。DEX组48 h时血浆NE、多巴胺和多巴酚丁胺水平均明显低于咪达唑仑组〔NE（ng/L）：1 850.12（342.16，2 938.05）比4 596.60（3 310.56，5 546.84），多巴胺（ng/L）：119.10（60.47，200.71）比275.40（214.61，418.88），多巴酚丁胺（ng/L）：51.20（36.85，75.59）比98.97（85.65，107.10），均n P0.05〕。n 结论:DEX较咪达唑仑更能降低脓毒性休克患者血浆儿茶酚胺水平，且并不增加外源性NE用量，对脓毒性休克患者血流动力学的影响也较咪达唑仑小。“,”Objective:To compare the effects of dexmedetomidine (DEX) and midazolam on the endogenous plasma catecholamine levels and the dosage of exogenous norepinephrine (NE) to maintain blood pressure in patients with septic shock.Methods:From January 2018 to December 2019, patients admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University who needed invasive mechanical ventilation and had a stay of more than 48 hours in the intensive care unit (ICU) for septic shock and received DEX or midazolam for sedation were enrolled in this study. The hemodynamic data, arterial blood lactic acid (Lac) level, arterial blood gas analysis and vasoactive drug dose at 0, 12, 24, 48, 72 hours after entering the ICU were dynamically recorded, and the plasma catecholamine levels at 0, 24, 48 hours after entering the ICU were recorded. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score and sequential organ failure assessment (SOFA) score on ICU-admission were calculated. The parameters of prognosis were collected.Results:A total of 24 patients were enrolled, 12 in the DEX group and 12 in the midazolam group. There were similar dynamic trends in heart rate (HR), central venous pressure (CVP), venous-arterial carbon dioxide pressure difference (Pv-aCOn 2), oxygenation index (PaOn 2/FiOn 2), and Lac level of patients between the two groups. Only the 12-hour CVP and 72-hour Pv-aCOn 2 in the DEX group were significantly higher than those in the midazolam group [CVP (mmHg, 1 mmHg = 0.133 kPa): 13±3 vs. 10±3, Pv-aCOn 2 (mmHg): 9.4±5.2 vs. 4.8±2.2, both n P 0.05]. The levels of plasma NE, dopamine and dobutamine in the DEX group at 48 hours were significantly lower than those in the midazolam group [NE (ng/L): 1 850.12 (342.16, 2 938.05) vs. 4 596.60 (3 310.56, 5 546.84), dopamine (ng/L): 119.10 (60.47, 200.71) vs. 275.40 (214.61, 418.88), dobutamine (ng/L): 51.20 (36.85, 75.59) vs. 98.97 (85.65, 107.10), all n P 0.05].n Conclusion:DEX can reduce plasma catecholamine levels in patients with septic shock more than midazolam, and does not increase the dose of exogenous NE, and has a smaller effect on hemodynamics in patients with septic shock than midazolam.