| 摘要: |
| 目的：比较肾上腺素与多巴胺治疗儿童脓毒性休克的疗效。方法：采用前瞻性随机对照临床试验（RCT）研究方法，选择2013年2月至2015年2月入住我院PICU的脓毒性休克（给予充分液体复苏后仍存在低血压）的患儿60例，随机分为多巴胺组和肾上腺素组各30例并应用相应药物进行治疗。多巴胺起始剂量7.0 μg/（kg·min），如未达到治疗目标，每20 min增加2.5 μg/（kg·min），最大剂量20 μg/（kg·min）；肾上腺素起始剂量0.1 μg/（kg·min），每20 min增加0.1 μg/（kg·min），最大剂量0.3 μg/（kg·min）。比较两组患儿的血液动力学指标、氧代谢指标和病死率。结果：肾上腺素组平均动脉压（MAP）、射血分数（EF）、中心静脉血氧饱和度（ScvO2）、每小时尿量（UV）在用药后6 h、24 h均高于多巴胺组（P均<0.05）。两组患儿的心率（HR）、中心静脉压（CVP）在各时间点比较，差异均无统计学意义（P均>0.05）。肾上腺素组血清乳酸在用药后6 h高于多巴胺组（P<0.05）；在用药后24 h时，与多巴胺组比较，差异无统计学意义（P>0.05）。肾上腺素组病死率（16.67%）低于多巴胺组（40.00%），差异有统计学意义（P<0.05）。结论：与多巴胺相比，肾上腺素能更有效纠正脓毒性休克患儿的血流动力学及氧代谢异常，早期应用能改善预后。 |
| 关键词: 肾上腺素 多巴胺 脓毒性休克 血管活性药物 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2018.12.005 |
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| 基金项目: |
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| Comparative Study of Epinephrine and Dopamine in the Management of Pediatric Septic Shock |
| Zhu Jinlan, Mu Weike |
| (Shenzhen Children’ Hospital, Guangdong Shenzhen 518038, China) |
| Abstract: |
| Objective: The objective was to compare the abilitiy of epinephrine and dopamine in reversing the hemodynamic and metabolic abnormalities of children septic shock. Methods: Prospective randomize control study. Sixty cases of children who were met the clinical criteria for fluid-refractory septic shock in our hospital from Febrary, 2013 to Febrary, 2015 were selected and randomly divided into either dopamine group (DA) or epinephrine group (E). The patients in DA group were started on dopamine infusion at 7 μg/(kg·min) which was increased by 2.5 μg/(kg·min), every 20 minutes till the goals were achieved. The patients in E group received epinephrine infusion started at a dose of 0.1 μg/(kg·min) with a dose increment of 0.1 μg/(kg·min), every 20 minutes till the goals were achieved. These groups of patients’hymodynamic, metabolic parameters and mortality rates were compared. Results: The post-treatment MAP, EF and ScvO2 in E group was significantly higher than that in DA group (P<0.05). In a view to HR and CVP, there were insignificant differences at 6 h and 4 h (P>0.05). Serum lactate was significantly higher in E group (P<0.05) at 6 h, but was comparable in both groups at 24 h. The urine output was significantly higher in E group at 6 h, 24 h (P<0.05). The mortality rate was significantly lower in E group (P<0.05). Conclusion: Epinephrine was more useful in reversing the hemodynamic and metabolic abnormalities of hyperdynamic septic shock compared to dopamine. Early administration of epinephrine can improve outcome. |
| Key words: epinephrine dopamine septic shock vasoactive drug |
