多巴酚丁胺对感染性休克引起的急性呼吸窘迫综合征患者相关指标的影响
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篇名: 多巴酚丁胺对感染性休克引起的急性呼吸窘迫综合征患者相关指标的影响
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摘要: 目的:探讨多巴酚丁胺对感染性休克引起的急性呼吸窘迫综合征(ARDS)患者血流动力学、组织灌注及呼吸功能的影响。方法:26例感染性休克引起的ARDS患者均给予盐酸多巴酚丁胺注射液5 μg/(kg·min),持续泵注20 min,后每20 min增加5 μg/(kg·min),直至15 μg/(kg·min),持续泵注维持6 h,泵注过程中维持平均动脉压(MAP)在65 mmHg左右。记录所有患者用药前,用药后6、24、48 h的血流动力学指标[心率(HR)、平均动脉压(MAP)、心输出量(CO)、每搏输出量(SV)、全心舒张末期容积(GEDV)、胸腔内血容量指数(ITBI)、血管外肺水指数(ELWI)、外周血管阻力指数(SVRI)]、组织灌注量指标(去甲肾上腺素、尿量、血氧饱和度、血乳酸)、呼吸机参数指标(呼气末正压、每分钟通气量、呼吸频率、吸气峰压、平台压)。结果:患者用药前后HR、MAP、GEDV、ITBI、血氧饱和度、血乳酸、呼吸频率比较,差异均无统计学意义(P>0.05)。患者用药后6、24、 48 h的CO、SV、尿量、每分钟通气量均显著高于用药前,且随用药时间延长逐渐升高;用药后ELWI、SVRI、呼吸末正压、吸气峰压、平台压均显著低于用药前,且随用药时间延长逐渐降低,差异均有统计学意义(P<0.05)。患者用药后24、 48 h的去甲肾上腺素均显著低于用药前及用药后6 h,差异均有统计学意义(P<0.05),但用药前与用药后6 h比较,差异无统计学意义(P>0.05)。结论: 早期应用多巴酚丁胺可改善感染性休克引起的ARDS患者的ELWI、组织灌注及呼吸功能,稳定血流动力学。
ABSTRACT: OBJECTIVE: To explore the effects of dobutamine on hemodynamics, tissue perfusion and respiratory function in patients with ARDS caused by septic shock. METHODS: Totally 26 patients with ARDS caused by septic shock were given Dobutamine hydrochloride injection 5 μg/(kg·min) by continuous pump for 20 min, increasing by 5 μg/(kg·min) every 20 min to 15 μg/(kg·min) for 6 h. Mean artery pressure (MAP) maintained at about 65 mmHg during continuous pump. Hemodynamic indexes [HR, MAP, cardiac output (CO), stroke volume (SV), total end diastolic volume (GEDV), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI), systemic vascular resistance index (SVRI)], tissue perfusion indexes (norepinephrine, urine volume, blood oxygen saturation, blood lactate) and ventilator parameter indexes (positive breathing pressure, minute ventilation volume, respiratory rate, peak inspiratory pressure and plateau pressure) of all patients were recorded before medication, 6, 24, 48 h after medication. RESULTS: There were no statistical significances in HR, MAP, GEDV, ITBI, blood oxygen saturation, blood lactate and respiratory rate before and after treatment (P>0.05). CO, SV, urine volume and minute ventilation volume of all patients 6, 24, 48 h after medication were significantly higher than before medication, and those indexes increased gradually as medication time. ELWI, SVRI, positive breathing pressure, peak inspiratory pressure and plateau pressure of all patients after medication were significantly lower than before medication, and those indexes decreased gradually as medication time, with statistical significance (P<0.05). The levels of norepinephrine in all patients 24, 48 h after medication were significantly lower than before medication and 6 h after medication, with statistical significance (P<0.05); but there was no statistical significance between before medication and 6 h after medication (P>0.05). CONCLUSIONS: The early application of dobutamine ELWI, tissue perfusion and respiratory function in patients with ARDS caused by septic shock, and can keep hemodynamics stable.
期刊: 2017年第28卷第21期
作者: 徐凤玲,朱瑞,倪秀梅,周敏
AUTHORS: XU Fengling,ZHU Rui,NI Xiumei,ZHOU Min
关键字: 多巴酚丁胺;感染性休克;急性呼吸窘迫综合征;肺水指数;组织灌注;呼吸功能;血流动力学
KEYWORDS: Dobutamine; Septic shock; ARDS; Extravascular lung water index; Tissue perfusion; Respiratory function; Hemodynamics
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