消化道穿孔致感染性休克应用去甲肾上腺素与多巴胺的临床研究

目的探讨消化道穿孔致感染性休克应用去甲肾上腺素与多巴胺的效果。方法2015-01至2018-12选择聊城市人民医院消化道穿孔致重度感染性休克的患者87例,根据随机数字表法分为对照组(n=47)和观察组(n=40)。对照组采用多巴胺治疗法,观察组采用去甲肾上腺素治疗法。观察两组患者机械通气时间、入住重症监护病房(intensive care unit,ICU)时间、平均每日补液量。记录两组患者治疗1周后患者心率(heart rate,HR)、中心静脉压(central venous pressure,CVP)、平均动脉压(mean arterial pressure,MAP)。记录两组患者心功能指标,包括每分输出量(cardiac output,CO)、左心室射血分数(left ventricular ejection fraction,LVEF)、血浆心肌肌钙蛋白(cardiac troponin I,cTnI)。观察两组患者急性生理学及慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、多器官功能障碍综合症(multiple organ dysfunction syndrome,MODS)评分。比较两组患者并发症发生率。结果(1)观察组机械通气时间(4.69±1.53)、入住ICU时间(8.21±2.56)、平均每日补液量(3567.23±65.19)显著低于对照组,差异均有统计学意义(P<0.05);(2)治疗后,两组患者HR较治疗前显著降低,CVP、MAP较治疗前显著升高,且观察组HR(91.26±6.23)显著低于对照组,CVP(13.15±1.18)、MAP(74.23±8.55)显著高于对照组,差异均有统计学意义(P<0.05);(3)治疗后,观察组CO(5.23±1.32)、LVEF(48.81±6.59)显著高于对照组,cTnI(1.01±0.12)低于对照组,差异均有统计学意义(P<0.05);(4)治疗后,两组患者APACHEⅡ评分、MODS评分均较治疗前显著下降,且观察组APACHEⅡ评分(10.53±1.62)、MODS评分(5.15±1.38)较对照组明显下降,差异均有统计学意义(P<0.05);(5)观察组患者MODS(12.50%)、急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)(7.50%)、弥散性血管内凝血(disseminated intravascular coagulation,DIC)(2.50%)发病率显著低于对照组,差异具有统计学意义(P<0.05)。结论对于消化道穿孔致感染性休克患者而言,多巴胺和去甲肾上腺素均为有效的药物,二者间哪一种疗效与安全性更具优势,现阶段依然存在较多争议,本研究结果显示,与多巴胺对比,去甲肾上腺素更具优势。

Clinical study of noradrenaline and dopamine in septic shock caused by gastrointestinal perforation

Objective To investigate the effect of noradrenaline and dopamine on septic shock caused by gastrointestinal perforation.Methods 87 patients with septic shock caused by perforation of digestive tract treated in our hospital from January 2015 to December 2018 were selected and divided into control group(n=47)and observation group(n=40)according to the random number table method.The control group was treated with dopamine,the observation group was treated with noradrenaline.The time of mechanical ventilation,the time of admission to ICU and the volume of fluid infusion were observed.Heart rate(HR),central venous pressure(CVP)and mean arterial pressure(MAP)were recorded in two groups after 1 week of treatment.Cardiac function indexes were recorded,including output per minute(CO),ventricular ejection fraction(LVEF),and cardiac troponin I(cTnI).The acute physiology and chronic health evaluationⅡ(APACHEⅡ)and multiple organ dysfunction syndrome(MODS)of the two groups were observed.The incidence of complications was compared between the two groups.Results(1)The time of mechanical ventilation(4.69±1.53),the time of admission to ICU(8.21±2.56)and the amount of fluid replenishment(3567.23±65.19)in the observation group were significantly lower than those in the control group(P<0.05).(2)After treatment,HR in the two groups was significantly lower than that before treatment,CVP and MAP were significantly higher than those before treatment,and HR(91.26±6.23)in the observation group was significantly lower than that in the control group,CVP(13.15±1.18)and MAP(74.23±8.55)were significantly higher than those in the control group(P<0.05).(3)After treatment,CO(5.23±1.32)and LVEF(48.81±6.59)in the observation group were significantly higher than those in the control group,and cTnI(1.01±0.12)was lower than that of the control group(P<0.05).(4)After treatment,APACHEⅡscore and MODS score in the two groups were significantly lower than those before treatment,and APACHEⅡscore(10.53±1.62)and MODS score(5.15±1.38)in the observation group were lower than those in the control group(P<0.05).The incidence of MODS(12.50%),ARDS(7.50%)and DIC(2.50%)in the observation group was significantly lower than that in the control group(P<0.05).Conclusions Dopamine and noradrenaline are effective drugs for septic shock patients caused by perforation of digestive tract.It remains unclear and disputable that which of them has more advantages in efficacy and safety.The results of this study show that compared with dopamine,nor adrenaline has more advantages.