摘要
目的观察间羟胺对感染性休克患者血压、心率和肾脏功能的影响。方法根据病情相近、病因相同、年龄相仿的原则收集1995年以来在我科ICU接受治疗的感染性休克患者70例。所有患者在休克发生后,均根据病情变化随时调整间羟胺用量,以维持血压稳定。然后根据临床使用间羟胺剂量的大小,将患者分成3组:小剂量组[A组,n=23,最大泵速为0.5～5μg/(kg.min)]、中剂量组[B组,n=23,最大泵速为6～10μg/(kg.min)]、大剂量组[C组,n=24,最大泵速为>11μg/(kg.min)]。在治疗前对患者进行APACHEIII评分,记录其血压、心率变化及尿量、BUN(血尿素氮)、CRE(肌酐)、尿ALB(白蛋白)和β2-MG(β2-微球蛋白)定量等肾功指标变化。结果抗休克治疗前,B组患者的APACHEIII评分显著高于A组,但低于C组(P<0.01),说明3组患者的病情依次加重;所有患者BUN、CRE、尿ALB和β2-MG定量均异常升高,但组间差异无统计学意义;抗休克治疗开始后,患者尿量、BUN、CRE及尿ALB和β2-MG定量也逐步恢复(与治疗前相比,均P<0.01),但组间各指标随时间变化差异无统计学意义。结论间羟胺用于感染性休克时,患者肾功的恢复与血流动力学的稳定相关,而与间羟胺剂量的关系不大。
AIM To study the effect of metaraminol on the renal function in the patients with septic shock. METHODS Seventy patients with septic shock, who had been admitted into ICU of Department of Anesthesiology, Xijing Hospital since 1995 were enrolled in this study. The dosage of metaraminol had been adjusted to maintain the stability of arterial blood pressure for all the patients with septic shock according to the changes in their conditions. Based on the dosage of metaraminol used clinically and our experiences, all the patients were divided into three groups： Group A had 23 cases with the biggest infusing rate of 0.5 - 5 μg/（ kg·min） during anti-shock therapy, Group B had 23 cases with the biggest infusing rate of 6 - 10 μg/（ kg·min）, and Group C had 24 cases with the biggest infusing rate of 〉 11 μg/（ kg·min）. APACHEⅢ scoring was made for all the patients before the anti-shock therapy, and the changes in arterial blood pressure, heart rate （HR）, urinary output, blood urea nitrogen （BUN）, creatinine （CRE）, urinary albumin （ALB） and β2-microglobulin （β2-MG） were recorded. RESULTS Before the anti-shock therapy, the APACHEⅢ scoring in Group B was higher than that in Group A, but lower than that in Group C （P 〈0.01）. The levels of BUN, CRE, urine ALB and I32-MG output were abnormally high in all the patients, but with no statistical significance among the three groups. After the anti- shock therapy, the urine output, BUN, CRE, urine ALB and β2-MG output gradually decreased compared with those before treatment （P 〈0.01 ） but with no statistical significance among the three groups. CONCLUSION Metaraminol promotes the restoration of the abnormal renal function in patients with septic shock, which is related to the hemodynamic stability and not the dosage of metaraminol used.
出处
《心脏杂志》
CAS
2007年第6期709-712,共4页
Chinese Heart Journal
