中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2009年
3期
253-255,259
,共4页
感染性休克%胃黏膜二氧化碳分压%多巴胺%多巴酚丁胺%去甲肾上腺素
感染性休剋%胃黏膜二氧化碳分壓%多巴胺%多巴酚丁胺%去甲腎上腺素
감염성휴극%위점막이양화탄분압%다파알%다파분정알%거갑신상선소
Septic shock%Gastric mucosal carbon dioxide tension%Dopamine%Dobutamine%Norepinephrine
目的 评价多巴胺、多巴酚丁胺和去甲肾上腺素对感染性休克兔胃黏膜二氧化碳分压与动脉血二氧化碳分压差[P(g-a),CO2]及肠系膜上动脉血流量的影响.方法 静脉注入内毒素复制兔感染性休克模型,达到休克标准后随机分成3组:多巴胺组、多巴酚丁胺组和去甲肾上腺素组,每组各8只.每组均按20 ml/(kg·h)输注生理盐水进行容量复苏,同时分别持续静脉滴注多巴胺5μg/(kg·min)、多巴酚丁胺5 μg/(kg·min)和去甲肾上腺素1μg/(kg·min).连续监测平均动脉压、心率、心脏指数和肠系膜上动脉血流指数,每10分钟测定胃黏膜二氧化碳分压1次,每小时进行动静脉血气分析并测定动脉血乳酸.结果 静脉注射内毒素后,3组平均动脉压、心脏指数及肠系膜血流量指数均明显下降,但P(g-a)CO2明显增加,氧输送能力下降,动脉血乳酸升高.分组干预2 h后,去甲肾上腺素组的平均动脉压为(70±3)mm Hg(1 mm Hg=0.133 kPa),明显高于多巴胺组[(66±4)mm Hg]和多巴酚丁胺组[(65±4)mm Hg],差异有显著性(P＜0.05);去甲肾上腺素组的肠系膜血流量指数[(18.7±2.9)ml/(kg·min)]亦明显高于多巴胺组[(16.2±1.6 ml/(kg·min)]和多巴酚丁胺组[(15.8±1.9)ml/(kg·min)],差异有显著性(P＜0.05);去甲肾上腺素组P(g-a)CO2[(30±6)mm Hg]较多巴酚丁胺组[(23±5)mm Hg]明显降低(P＜0.05).结论 感染性休克兔进行容量复苏时,去甲肾上腺素对胃肠灌注的改善较小剂量多巴胺和多巴酚丁胺更为明显.
目的 評價多巴胺、多巴酚丁胺和去甲腎上腺素對感染性休剋兔胃黏膜二氧化碳分壓與動脈血二氧化碳分壓差[P(g-a),CO2]及腸繫膜上動脈血流量的影響.方法 靜脈註入內毒素複製兔感染性休剋模型,達到休剋標準後隨機分成3組:多巴胺組、多巴酚丁胺組和去甲腎上腺素組,每組各8隻.每組均按20 ml/(kg·h)輸註生理鹽水進行容量複囌,同時分彆持續靜脈滴註多巴胺5μg/(kg·min)、多巴酚丁胺5 μg/(kg·min)和去甲腎上腺素1μg/(kg·min).連續鑑測平均動脈壓、心率、心髒指數和腸繫膜上動脈血流指數,每10分鐘測定胃黏膜二氧化碳分壓1次,每小時進行動靜脈血氣分析併測定動脈血乳痠.結果 靜脈註射內毒素後,3組平均動脈壓、心髒指數及腸繫膜血流量指數均明顯下降,但P(g-a)CO2明顯增加,氧輸送能力下降,動脈血乳痠升高.分組榦預2 h後,去甲腎上腺素組的平均動脈壓為(70±3)mm Hg(1 mm Hg=0.133 kPa),明顯高于多巴胺組[(66±4)mm Hg]和多巴酚丁胺組[(65±4)mm Hg],差異有顯著性(P＜0.05);去甲腎上腺素組的腸繫膜血流量指數[(18.7±2.9)ml/(kg·min)]亦明顯高于多巴胺組[(16.2±1.6 ml/(kg·min)]和多巴酚丁胺組[(15.8±1.9)ml/(kg·min)],差異有顯著性(P＜0.05);去甲腎上腺素組P(g-a)CO2[(30±6)mm Hg]較多巴酚丁胺組[(23±5)mm Hg]明顯降低(P＜0.05).結論 感染性休剋兔進行容量複囌時,去甲腎上腺素對胃腸灌註的改善較小劑量多巴胺和多巴酚丁胺更為明顯.
목적 평개다파알、다파분정알화거갑신상선소대감염성휴극토위점막이양화탄분압여동맥혈이양화탄분압차[P(g-a),CO2]급장계막상동맥혈류량적영향.방법 정맥주입내독소복제토감염성휴극모형,체도휴극표준후수궤분성3조:다파알조、다파분정알조화거갑신상선소조,매조각8지.매조균안20 ml/(kg·h)수주생리염수진행용량복소,동시분별지속정맥적주다파알5μg/(kg·min)、다파분정알5 μg/(kg·min)화거갑신상선소1μg/(kg·min).련속감측평균동맥압、심솔、심장지수화장계막상동맥혈류지수,매10분종측정위점막이양화탄분압1차,매소시진행동정맥혈기분석병측정동맥혈유산.결과 정맥주사내독소후,3조평균동맥압、심장지수급장계막혈류량지수균명현하강,단P(g-a)CO2명현증가,양수송능력하강,동맥혈유산승고.분조간예2 h후,거갑신상선소조적평균동맥압위(70±3)mm Hg(1 mm Hg=0.133 kPa),명현고우다파알조[(66±4)mm Hg]화다파분정알조[(65±4)mm Hg],차이유현저성(P＜0.05);거갑신상선소조적장계막혈류량지수[(18.7±2.9)ml/(kg·min)]역명현고우다파알조[(16.2±1.6 ml/(kg·min)]화다파분정알조[(15.8±1.9)ml/(kg·min)],차이유현저성(P＜0.05);거갑신상선소조P(g-a)CO2[(30±6)mm Hg]교다파분정알조[(23±5)mm Hg]명현강저(P＜0.05).결론 감염성휴극토진행용량복소시,거갑신상선소대위장관주적개선교소제량다파알화다파분정알경위명현.
Objective To assess the effects of dopamine,dobutamine and norepinephrine on the P(g-a)CO2 and superior mesenteric blood flow in septic shock.Methods Rabbit septic shock model was established by challenging with intravenous injection of lipopolysaccharides from Escherichia coil(2 mg/kg).The rabbits with septic shock were randomly assigned to 3 groups-dopamine group(n = 8),dobutamine group(n = 8) and norepinephrine group(n = 8).Apart from volume resuscitation with normal saline solution [20 ml/(kg· h)]，dopamine[5μg/(kg·min)],dobutamine[(5μg/(kg·min)]and norepinephrine [(1μg/(kg·min)]were infused in dopamine group,dobutamine group and norepinephrine group respeclively.Cardiac index(CI) and superior mesenteric blood flow index(SMBFI) were continuously monitored by doppler flowrneter.Gastric mucosal PCO2 was evaluated by gas tonometry every 10 min.Arterial and venous blood gas analyses and lactate levels were measured every 1 h.Results MAP,CI,and SMBFI significandy decreased and P(g-a) CO2 increased after lipopolysaccharides infusion in three groups.After 2-hour treatment,MAP in norepinephrine group[(70 +3) mm Hg]was higher than that of dopamine group[(66±4) mm Hg]and dobutamine group[(65±4) mm Hg](P ＜0.05).SMBFI in norepinephrine group [(18.7±2.9) ml/(kg·min)]was higher than that of dopamine group[(16.2±1.6) ml/(kg·min)]and dobutamine group[(15.8±1.9) ml/(kg·min)](P＜0.05).P(g-a) CO2 in norepinephrine group [(30±6) mm Hg]was lower than that of dobutamine group[(23±5)mm Hg](P＜0.05).Condnsion As an adjuvant therapy of volume resuscitation,norepinephrine is more effective than low dose dopamine and dobutamine in improving splanchnic perfusion.
