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目的探讨多巴胺(dopamine,DA)与去甲肾上腺素(norepinephrine,NE)对肾移植术后感染性休克患者血流动力学及肾脏灌注的影响。方法符合入选标准的肾移植术后感染性休克患者23例,随机分组为DA治疗组和NE治疗组,记录治疗前(T0)、治疗后6、12、24、48h的心率(HR)、平均动脉压(MAP)、体循环阻力指数(SVRI)、心脏指数(CI)、血乳酸(LAC)、混和静脉血氧饱和度(ScVO2)、每小时尿量(UV)、肌酐清除率(Ccr)、血清肌酐(Scr)。结果两组患者治疗后各时间点MAP、SVRI、CI、ScVO2较同组T0明显增加(P<0.05),但两组间同时间点比较,差异无统计学意义。DA组患者治疗后HR上升,但与同组T0相比,差异无统计学意义;NE组HR从12h后明显低于同组T0(P<0.05),且较DA组治疗后各时间点亦明显降低(P<0.05)。两组治疗后LAC呈下降趋势,24h和48h明显低于同组T0(P<0.05),但两组间同时间点比较,差异无统计学意义。两组患者治疗后各时间点UV、Ccr较同组T0明显增加(P<0.05),其中NE组UV从12h开始明显高于DA组(P<0.05);两组Scr变化不明显。结论 NE在内脏灌注、组织氧代谢和改善肾功能方面优于DA,对于肾移植术后感染性休克患者,NE可能是更好的选择。
Objective To investigate the effects of dopamine (DA) and norepinephrine (NE) on hemodynamics and renal perfusion in septic shock patients after renal transplantation. Methods Twenty-three patients with septic shock after renal transplantation were enrolled in this study. They were randomly divided into DA and NE treatment groups. Before treatment (T0), heart rate (HR) at 6, 12, 24 and 48 hours after treatment were recorded, mean Arterial pressure, SVRI, CI, LAC, ScVO2, UV, Ccr, Serum creatinine (Scr). Results The MAP, SVRI, CI, ScVO2 of the two groups after treatment were significantly higher than those of the same group (P <0.05), but there was no significant difference between the two groups at the same time point. HR in DA group increased after treatment, but there was no significant difference compared with T0 in the same group; HR in NE group was significantly lower than T0 in the same group after 12 hours (P <0.05) Significantly lower (P <0.05). After treatment LAC showed a downward trend, significantly lower than the same group T0 24h, 48h, but no significant difference between the two groups at the same time point. The levels of UV and Ccr in both groups were significantly higher than those in the same group (P <0.05), and the UV of NE group was significantly higher than that of DA group at 12h (P <0.05). There was no obvious change of Scr in both groups. Conclusion NE is superior to DA in visceral perfusion, tissue oxygen metabolism and renal function improvement, and NE may be a better choice for patients with septic shock after kidney transplantation.