武杰

【摘要】 目的：探討去甲肾上腺素对感染性休克患者血管阻力和氧代谢状态的影响。方法：选取2020年3-12月本院收治的感染性休克患者98例，按照随机数字表法分为观察组和对照组，各49例。对照组患者采用多巴胺治疗，观察组给予去甲肾上腺素治疗，比较两组给药前（T0）、给药后1 h（T1）、3 h（T3）、6 h（T6）的血流动力学指标[心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）、心排指数（CI）和外周血管阻力指数（SVRI）]、氧代谢指标[氧供指数（DO2）、氧耗指数（VO2）、氧摄指数（O2ext）、血氧饱和度（SvO2）和乳酸清除率]，并比较两组用药后4周内的不良反应发生情况。结果：T0，两组HR、MAP、CVP、CI、SVRI比较，差异均无统计学意义（P>0.05）;观察组T1、T3、T6的HR较T0均显著降低，且均显著低于对照组（P<0.05）。观察组T6的MAP、CVP、SVRI较治疗前均显著升高，且均显著高于对照组（P<0.05）。T0，两组DO2、VO2、O2ext、SvO2比较，差异均无统计学意义（P>0.05）。与T0比较，观察组T1、T3、T6的DO2显著升高，但T3、T6时均显著低于对照组（P<0.05）;与T0比较，观察组T1、T3、T6的VO2、O2ext、SvO2均显著升高，且均显著高于对照组（P<0.05）;观察组T1、T3、T6的乳酸清除率均显著高于对照组（P<0.05）。观察组不良反应总发生率为4.08%，对照组为16.33%，差异有统计学意义（P<0.05）。结论：去甲肾上腺素较多巴胺能更为有效地改善感染性休克患者血管阻力和组织氧代谢。

【关键词】 去甲肾上腺素 感染性休克 血管阻力 氧代谢状态

Study on the Effect of Norepinephrine on Vascular Resistance and Oxygen Metabolism Status in Patients with Septic shock/WU Jie. //Medical Innovation of China， 2021， 18（33）： -156

[Abstract] Objective： To investigate the effect of Norepinephrine on vascular resistance and oxygen metabolism in patients with septic shock. Method： A total of 98 patients with septic shock admitted to our hospital from March to December 2020 were selected and divided into observation group and control group according to random number table method， with 49 cases in each group. The control group was treated with Dopamine and the observation group was treated with Norepinephrine. The hemodynamic indexes [heart rate （HR）， mean arterial pressure （MAP）， central venous pressure （CVP）， cardiac output index （CI） and peripheral vascular resistance index （SVRI）]， oxygen metabolism indexes [oxygen supply index （DO2）， oxygen consumption index （VO2） and oxygen uptake index （O2ext）， blood oxygen saturation （SvO2） and lactate clearance rate] were compared between the two groups before administration （T0）， 1 h after administration （T1）， 3 h after administration （T3）， 6 h after administration （T6） after administration， and the adverse reactions of the two groups of patients within 4 weeks after medication were compared. Result： T0， there were no significant differences in HR， MAP， CVP， CI and SVRI between the two groups （P>0.05）; HR of T1， T3 and T6 in observation group were significantly lower than that in T0， and significantly lower than those in control group （P<0.05）. MAP， CVP and SVRI of T6 in the observation group were significantly higher than those in T0， and were significantly higher than those in the control group （P<0.05）. T0， there were no statistical significance in DO2， VO2， O2ext， SvO2 between the two groups （P>0.05）. Compared with T0， DO2 at T1， T3 and T6 in observation group were significantly increased， but at T3 and T6 were significantly lower than those in control group （P<0.05）. Compared with T0， the VO2， O2ext， SvO2 of T1， T3 and T6 in observation group were significantly increased， and were significantly higher than those in control group （P<0.05）; lactate clearance rates of T1， T3 and T6 in observation group were significantlly higher than those in control group （P<0.05）. The total incidence of adverse reactions was 4.08% in the observation group and 16.33% in the control group， the difference was statistically significant （P<0.05）. Conclusion： Compared with Dopamine， Norepinephrine can more effectively improve vascular resistance and tissue oxygen metabolism in patients with septic shock.

[Key words] Norepinephrine Septic shock Vascular resistance Oxygen metabolism status

First-author’s address： Jiamusi Central Hospital， Jiamusi 154002， China

doi：10.3969/j.issn.1674-4985.2021.33.037

感染性休克又称脓毒性休克，是由病原微生物及其毒素等产物引起的休克。早期临床表现为体循环低血容量，组织灌注不足，细胞代谢紊乱，随着病情的加重，细胞缺氧形成不可逆损伤，以及微循环受损，血液循环异常，或形成微血栓，甚至导致多器官衰竭，严重威胁着患者的生命安全[1-2]。……