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Comparison of effect of norepinephrine-dobutamine and that of dopamine alone on splanchnic perfusion in sheep with septic shock
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- Author:
- No author available
- Journal Title:
- CHINESE CRITICAL CARE MEDICINE
- Issue:
- 11
- DOI:
- 10.3760/j.issn:1003-0603.2003.11.005
- Key Word:
- 休克,感染性;多巴酚丁胺;去甲肾上腺素;多巴胺;黏膜内pH;血流动力学
Abstract： 目的:观察多巴酚丁胺联用去甲肾上腺素和多巴胺对感染性休克绵羊内脏灌注的影响.方法:静脉注射内毒素(LPS)复制绵羊感染性休克模型,当收缩压下降至低于90.00 mm Hg(1 mm Hg=0.133 kPa)或较LPS注射前降低39.75 mm Hg时记录血流动力学及肠黏膜pH(pHi)的基础值.20只绵羊随机分为两组,分别静脉注射多巴酚丁胺加去甲肾上腺素和多巴胺,调整药物剂量,使平均动脉压升高到90.00 mm Hg,观察药物使用前(基础值)及用药后1、2、3、4 h的血流动力学和内脏灌注指标pHi.结果:在LPS注射前和基础状态,多巴胺组与多巴酚丁胺+去甲肾上腺素组的血流动力学、氧代谢和肠道pHi指标均无明显差异;与基础值相比,两组动物在用药后血压、心脏指数及氧输送明显升高.多巴胺组用药4 h动脉乳酸浓度及pHi水平与基础值比较无明显改变;但动脉pH值基础水平为7.40±0.05,多巴胺应用1 h后显著降低至7.26±0.06 ( P<0.05 ).应用多巴酚丁胺加去甲肾上腺素后3和4 h,动脉乳酸浓度分别为 (2.3±1.1) mmol/L和(2.1±1.1)mmol/L,均显著低于基础水平(4.0±1.8)mmol/L(P<0.05).应用多巴酚丁胺加去甲肾上腺素前动物pHi为7.19±0.04,用药后3 h,pHi 明显升高到7.36±0.07 (P<0.05).结论:多巴酚丁胺加去甲肾上腺素和多巴胺均能改善感染性休克绵羊全身血流动力学状态,但在改善内脏灌注上,多巴酚丁胺联用去甲肾上腺素明显优于多巴胺.
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