感染性休克血管活性药物进展PPT.ppt

Effect of Epi vs NE +Dobu 血管活性药物对肾脏功能的影响 Dopa Dobu Epi NE NE+Dopa 肾血流量 - ? ? - - 尿量 ? - ~ ? ? Unaex ? ~ ~ - ? FEna ? ~ ~ - ? Ccr - ? ? ? - 感染性休克的肾脏保护性药物 去甲肾上腺素 多巴酚丁胺 Notice (1) Renal dose dopamine Protective effect on kidney By reducing oxygen demand By maintaining tubular flow Notice (2) 21 century strategies of ARF by NIH Renal dose dopamine is not recommended 二、血管活性药物与肠系膜血流供应 1. Dopa与NE比较 试验设计：随机对照试验 病例选择：感染性休克20例 高CI低SVRI、MAP60mmHg 分组? Aim: MAP75mmHg Dopa NE From：JAMA,1994,272:1354 Effect of NE vs Dopa on MAP NE Dopa Baseline 3h Baseline 3h MAP 55 87* 63 87* CI 4.2 4.7 4.2 5.3* PAWP 15 16 15 16 SVRI 1110 1405* 1035 1221 Effect of NE vs Dopa on DO2 and VO2 Effect of NE vs Dopa on pHi Comment 1. NE: DO2、VO2、pHi均增加 2. Dopa DO2增加, 但pHi降低 肠道氧债增加 Effect of dopa vs NE on DO2 of gut Critical Care Med, 1993, 21: 1296 Dopa in animal exp. Net increased gut blood flow But redistribution away from gut mucosa Dopa in hemorrhagic shock dog Dopa decreased the ability of gut to extract oxygen Effect of dopa vs NE on gut Comment ---Dopamine Increase CI, DO2, VO2 Increase DO2 of gut Increase gut mucosal oxygen need? Redistribution blood away from gut mocosal VO2 of gut decreased Splanchnic oxygen debt 2. Epi与NE 比较 (1) Prospective, controlled, randomized crossover study 12 patients with septic shock Patient groups Epi Aim: MAP 70~80mmHg NE From Crit Care Med, 1999,27:893 Effect of Epi vs NE on CI and DO2 NE Epi MAP 74 74 PAWP 15 14 CI 4.4 5.2* DO2 563 671* VO2 150 158 O2 ext 0.28 0.24 Effect of Epi vs NE on pHi and GMP NE Epi pHi 7.24 7.25 deltaPCO2 13 13 GMP 256 350* GMP/DO2 0.52 0.46 Comment Gastric mucosal perfusion: Epi NE Gut ischemia: improved by Epi?? Epi与NE 比较(2) Porcine endotoxin shock Epi Aim: MAP 70mmHg NE Dopex From Annals of Surgery, 1998,228:239 Effect of NE and Epi on mucosa Comment Epinephrine induce gut d