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目的:探讨去甲肾上腺素联合多巴酚丁胺治疗感染性休克对患者血流动力学、血乳酸及肌酐清除率(CCr)、滤过水排泄分数(FEH_2O)、滤过钠排泄分数(FENa)的影响。方法:研究对象选自我院2013年1月~2016年12月收治的120例感染性休克患者,采取随机数字表将其分成两组,每组60例。两组患者均采用多巴酚丁胺治疗,观察组在此基础上联合采用去甲肾上腺素治疗,对照组给予多巴胺治疗,对比两组临床疗效以及治疗前后血流动力学指标、血乳酸、CCr、FEH_2O、FENa水平的变化。结果:两组治疗后6、12、24、48 h血乳酸、FENa水平逐渐下降,且均明显低于治疗前;CCr、FEH_2O水平逐渐升高,且均明显高于治疗前(P<0.01)。观察组治疗后6、12、24、48 h血乳酸、FENa水平均显著低于对照组同时点(P<0.01),FEH_2O水平显著高于对照组同时点(P<0.01)。两组治疗后6、12、24、48 h MAP、SVRI均较治疗前显著升高,治疗后24、48 h CI较治疗前显著升高(P<0.01),观察组治疗后6、12、24、48 h MAP较治疗前显著降低(P<0.01),对照组治疗后6、12 h MAP较治疗前显著升高(P<0.01),观察组治疗后6、12、24、48 h HR显著低于对照组,SVRI显著高于对照组(P<0.01)。观察组治疗28 d病死率为18.33%,对照组为35.00%,观察组病死率明显低于对照组(P<0.05)。结论:去甲肾上腺素联合多巴酚丁胺治疗感染性休克可有效改善患者的血流动力学,降低血乳酸水平,改善肾脏灌注和患者预后。
Objective: To investigate the effects of norepinephrine and dobutamine on septic shock in patients with hemodynamics, blood lactate and creatinine clearance rate (CCr), filtration water excretion fraction (FEH_2O), filtration sodium excretion fraction (FENa )Impact. Methods: The subjects were selected from 120 patients with septic shock who were admitted to our hospital from January 2013 to December 2016. The patients were divided into two groups according to a random number table, with 60 cases in each group. Both groups were treated with dobutamine, the observation group was treated with norepinephrine on the basis of the above, and the control group was given dopamine treatment. The curative effect and the hemodynamics, blood lactate, CCr , FEH2O, FENa level changes. Results: The levels of lactic acid and FENa decreased gradually at 6, 12, 24 and 48 h after treatment in both groups, and both were significantly lower than those before treatment. The levels of CCr and FEH 2 O in the two groups were significantly higher than those before treatment (P <0.01) . The levels of lactic acid and FENa at 6, 12, 24 and 48 h after treatment in observation group were significantly lower than those in control group (P <0.01), FEH 2 O in observation group was significantly higher than that in control group at the same time point (P <0.01). The MAP and SVRI at 6, 12, 24 and 48 h after treatment in both groups were significantly higher than those before treatment, CI at 24 and 48 h after treatment were significantly higher than those before treatment (P <0.01) 24 h and 48 h MAP were significantly lower than those before treatment (P <0.01), MAP in 6 and 12 h after treatment in control group was significantly higher than that before treatment (P <0.01), and HR in observation group was significantly higher at 6, 12, 24 and 48 h after treatment SVRI was significantly lower than that of the control group (P <0.01). The 28-day mortality rate was 18.33% in the observation group and 35.00% in the control group. The mortality in the observation group was significantly lower than that in the control group (P <0.05). Conclusion: Norepinephrine combined with dobutamine in the treatment of septic shock can effectively improve the patient’s hemodynamics, lower blood lactate levels and improve renal perfusion and prognosis.