多巴胺联合去甲肾上腺素对早期危重病人血流动力学的稳定作用.DOC

多巴胺联合去甲肾上腺素对危重病人血流动力学的稳定作用 游波1，许月明1，陈虎平1，冯春森1 (400020重庆,中国人民解放军第324医院ICU1 ) [摘要] 目的 评价多巴胺联合去甲肾上腺素对稳定危重病人全身流动力学的作用。方法 我院ICU在2007-01-01至2010-10-01收治的血流动力学不稳定患者160例，前瞻性研究，按给予微量泵输注多巴胺及去甲肾上腺素的方法不同进行随机分组，分为A组：按常规给予多巴胺(1-20 ug.kg-1.min-1)；B组：多巴胺(1-10ug.kg-1.min-1)+去甲肾上腺素(0.03-3ug.kg-1.min-1)。记录0、12、24、48h的平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、尿量、血肌酐（Cr）、血尿素氮（BUN）监测值以及APACHEⅡ评分，统计维持平均动脉压的有效率、心律失常发生率及死亡率。结果 两组患者均能改善血流动力学参数，提高MAP，增加尿量，降低HR，但组间比较A组心率快于B组，B组增加尿量比A组更早更明显；两组均改善APACHEⅡ评分。A组对血流动力学控制满意者占67.50%，低于B组的86.60%；A组中心律失常占27.50%，显著高于B组的10.00%。其中A组最终对多巴胺不敏感有26例，占32.50%。两组死亡率无差异性。结论 多巴胺联合去甲肾上腺素较单纯应用多巴胺更能有效地改善血流动力学指标，改善肾功能，减少心律失常并发症，可能是ICU维持危重病人血流动力学稳定的一种更好方法。 [关键词] 多巴胺；去甲肾上腺素；血流动力学；休克 Effects of dopamine and norepinephrine on the stable of hemodynamics in early critically ill patients You bo1，Xu yueming1，Chen huping1，Fen Chunsen1（the ICU of PLA 324 hospital1，Chongqing 400020，China） ［Abstract］ Objective? To investigate the effect on?hemodynamic in early critically ill patients treated with dopamine and norepinephrine. Methods? Prospective,randomized,clinical trial in a medical intensive care unit ,totally 160 cases with unstable hemodynamic from Feb 1 2007 to Oct 1 2010, the cases were divided into Dopa group(group A), which treated with dopamine, and NE+Dopa group(group B),which treated with dopamine and norepinephrine. Patients in group A were treated with dopamine(1-20ug/kg-1.min-1) and treated with dopamine(1-10ug/ kg-1.min-1）+ norepinephrine (0.03-3ug/ kg-1.min-1）in group B. Hemodynamic variables including the mean arterial pressure (MAP),central venous pressure(CVP),heart rate(HR), urine volume, and other indexs serum creatinine(Cr),blood urea nitrogen(BUN), APACHE II score were observed at the time of 0, 12, 24, 48 hours after admission to ICU. Effective rate of maintaining the MAP, rate of arrhythmic events and mortality rate were analysised. Results? Each group can impove hemodynamics parameters, increase the MAP and urine volume and decrease the HR. The HR in group