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目的:观察多巴酚丁胺加去甲肾上腺素和单用多巴胺对感染性休克绵羊内脏灌注的影响.方法:利用内毒素(LPS)复制感染性休克模型,当收缩压下降至5.3kPa时记录血流动力学及肠粘膜pH(pH_i)的基础值.20只绵羊随机分为两组,分别静脉注入多巴酚丁胺加去甲肾上腺素及多巴胺,调整药物剂量,使平均动脉压升高到12kPa,观察用药前(基础值)及用药后1,2,3,4h的血流动力学和内脏灌注指标pH_i.结果:两组动物在用药后血压、心排指数及氧输送较用药前明显升高。多巴胺组动脉乳酸浓度及pH_i无明显改变,但动脉pH值在用药后1h从7.40±0.05降至7.26±0.06(P<0.05).应用多巴酚丁胺加去甲肾上腺素后3h和4h,动脉乳酸浓度从(4±2)mmol/L降至(2±1)mmol/L和(2±1)mmol/L(P<0.05),用药后3h,pH_i从7.19±0.04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单用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,多巴酚丁胺与去甲肾上腺素联用明显优于多巴胺单用.
OBJECTIVE: To observe the effects of dobutamine plus norepinephrine and dopamine on visceral perfusion in septic shock sheep.Methods: Septic shock models were replicated with endotoxin (LPS) and recorded when systolic blood pressure decreased to 5.3 kPa Hemodynamics and intestinal mucosal pH (pH_i) .20 sheep were randomly divided into two groups, respectively, intravenous injection of dobutamine plus norepinephrine and dopamine, adjust the drug dose, the average arterial pressure increased To 12kPa, before treatment (basal value) and 1, 2, 3, 4h after administration hemodynamics and visceral perfusion index pH_i.Results: After treatment, blood pressure, cardiac index and oxygen delivery Significantly increased. In the dopamine group, the arterial lactate concentration and pH_i had no significant change, but the arterial pH value decreased from 7.40 ± 0.05 to 7.26 ± 0.06 at 1h after administration (P <0.05) .3h and 4h after the application of dobutamine plus norepinephrine, The arterial lactate concentration decreased from (4 ± 2) mmol / L to (2 ± 1) mmol / L and (2 ± 1) mmol / L, P <0.05) 7.36 ± 0.07 (P <0.05) .Conclusion: Dobutamine plus norepinephrine and dopamine alone can improve systemic hemodynamics in septic shock sheep. However, in the improvement of visceral perfusion, dobutamine Amines and norepinephrine were significantly better than dopamine alone.