多巴酚丁胺在脓毒症休克患者的应用效果分析
Analysis of the application effect of dobutamine in septic shock patients
侯林 1吴雪 2孙自国3
作者信息
- 1. 巴中市恩阳区人民医院重症医学科,巴中 636000
- 2. 巴中市恩阳区人民医院呼吸与危重症医学科,巴中 636000
- 3. 巴中市中心医院重症医学科,巴中 636000
- 折叠
摘要
目的:探究多巴酚丁胺对脓毒症休克患者血乳酸、心肾功能和组织灌注的影响.方法:回顾分析我院2020年12月―2023年12月收治的脓毒症休克患者,根据治疗方案不同将其分为常规组与DOB组,常规组给予去甲肾上腺素治疗,DOB组在此基础上联合多巴酚丁胺治疗.经倾向性匹配排除混杂因素后,各组获得51例基线资料差异不显著的患者.对比两组治疗前、治疗第1、3、7 d的心率(HR)、血压(BP)、平均动脉压(MAP)、血乳酸(LAC)变化;比较治疗前、治疗第7 d的心功能[左室射血分数(LVEF)、心排指数(CI)、全心舒张末期容积(GEDVI)]、肾灌注[尿量(UV)、血清肌酐(Scr)]及肾脏滤过功能[滤过水排泄分数(FEH2O)、滤过钠排泄分数(FENa)]变化及28 d内死亡率.结果:HR、BP、MAP、LAC在组间、时间点、组间×时间点比较均具有差异,治疗1、3、7 d时DOB组HR、LAC均低于常规组,BP、MAP均高于常规组;治疗7 d后,两组LVEF、CI、GEDVI均上升,且DOB组均高于常规组;治疗7 d后,两组UV均上升,Scr下降,且DOB组UV高于常规组,Scr低于常规组;治疗7 d后,两组FEH2O上升,FENa下降,且DOB组FEH2O高于常规组,FENa低于常规组;常规组28 d内死亡11例(21.57%),平均生存时间(24.96±6.37)d;DOB组28 d内死亡7例(13.73%),平均生存时间(27.04±3.02)d.两组总生存率的比较,经log-rank χ2 检验,差异无统计学意义.结论:多巴酚丁胺可有效改善脓毒症休克患者心功能与肾功能,提高组织灌注量.
Abstract
Objective To explore the influence of dobutamine on blood lactic acid,cardiorenal function and tissue perfusion in patients with septic shock.Methods Patients with septic shock were retrospectively analyzed in our hospital from Decem-ber 2020 to December 2023.Both groups were given conventional treatment,and were divided into a conventional group and a DOB group according to different treatment plans.The conventional group received norepinephrine treatment,while the DOB group received a combination of dobutamine treatment on this basis.After propensity matching to exclude confounding factors,51 patients with no significant differences in baseline data were obtained in each group.The changes of heart rate(HR),blood pressure(BP),mean arterial pressure(MAP)and blood lactic acid(LAC)before treatment and on the 1st day,3rd day and 7th day of treatment,changes of cardiac function[left ventricular ejection fraction(LVEF),cardiac index(CI),global end-diastolic vol-ume index(GEDVI)],renal perfusion[urine volume(UV),serum creatinine(Scr)]and renal filtration function[filtered water excretion fraction(FEH2O),filtered sodium excretion fraction(FENa)]before treatment and on the 7th day of treatment and mortality within 28 days were compared between groups.Results There were significant differences in HR,BP,MAP and LAC from the aspects of between groups.On the 1st day,3rd day and 7th day of treatment,HR and LAC in DOB group were signifi-cantly lower than those in conventional group,and BP and MAP were significantly higher than those in conventional group.After 7 days of treatment,LVEF,CI and GEDVI in the two groups were increased significantly,and the DOB group had significantly higher LVEF,CI and GEDVI.UV in both groups after 7 days of treatment was risen significantly while Scr was declined signifi-cantly,and UV in DOB group was significantly higher while Scr was significantly lower compared to conventional group.After 7 days of treatment,FEH2O in both groups was significantly enhanced while FENa was significantly reduced,and FEH2O in DOB group was significantly higher than that in conventional groupwhile FENa was significantly lower.The number of dead cases within 28 days and average survival time were 11 cases(21.57%)and(24.96±6.37)d in conventional group and those in DOB group were 13.73%and(27.04±3.02)d.There was no significant difference in prognosis between the two groups.Conclusion Dobutamine can effectively improve cardiac function and renal function and enhance tissue perfusion in patients with septic shock.
关键词
多巴酚丁胺/去甲肾上腺素/脓毒症休克/肾灌注Key words
dobutamine/norepinephrine/sepsis shock/renal perfusion引用本文复制引用
基金项目
四川省医学会医学科研青年创新课题(Q21035)
出版年
2024
NETL
NSTL
万方数据