【摘要】 目的:研究多巴胺用于治疗感染性休克时对肾脏功能的影响。方法:按照病情相近、病因相同、年龄相仿的原则选择1998年以来在我科ICU接受治疗的感染性休克患者68例,分为3组:其中A组23例,B组23例,C组22例,3组多巴胺最大泵注速率依次为(1~5)μg·kg-1·min-1、(6~9)μg·kg-1·min-1、(10~15)μg·kg-1·min-1。测定、记录所有患者MAP、HR、尿量、BUN、CRE、U-ALB和Uβ2-MG定量及A-PACHE III评分。结果:治疗前,3组患者均表现有低血压、心动过速和少尿,多数患者CRE、BUN、U-ALB、Uβ2-MG和APACHE III评分高于正常值上限。经过抗休克治疗,所有患者的MAP、HR、尿量及BUN、CRE均恢复到正常范围(P<0.05或<0.01),U-ALB、Uβ2-MG定量及APACHE III评分也有所恢复(P<0.01),但仍高于正常。结论:在感染性休克的治疗中,应以恢复脏器血流灌注为首要目标,以容量复苏为主,必要时辅以多巴胺等血管活性药物来维持循环稳定。更多还原

【Abstract】 Objective:To study retrospectively the effect of dopamine on the renal function in the patients with septic shock. Methods: Sixty-eight patients with septic shock, with similar condition, cause and age admitted into ICU of our department since 1998, were enrolled in this study. They were divided into three groups according to the biggest infusing rate of dopamine used, group A had 23 cases administered with the biggest infusing rate of （1⁵）μg·kg -1 ·min -1 during anti-shock therapy, and group B had 23 cases with the biggest infusing rate of （6⁹）μg·kg -1 ·min -1 , and group C had 22 cases with the biggest infusing rate of （10¹5）μg·kg -1 ·min -1 . Mean arterial blood pressure（MAP）, heart rate（HR）, urine output, blood urea nitrogen（BUN）, creatinine（CRE）, urine albumin（U-ALB） and urine β₂-microglubulin（Uβ₂-MG） as well as APACHE III scoring were recorded . Results: Before anti-shock therapy , hypotension, tachycardia and oliguria occurred to all 68 patients with septic shock, and CRE, BUN, U-ALB, Uβ₂-MG and APACHE III scoring were abnormal in most cases. After anti-shock therapy, MAP, HR, urine output and BUN, CRE in all patients in the three groups gradually returned to normal levels（P<0.05 or <0.01 compared to that before anti-shock therapy）, and U-ALB, Uβ₂-MG output and APACHE III scoring also restored but still remained in abnormal levels （P<0.01 compared to that before anti-shock therapy）. Conclusion: The first goal to treat the patients with septic shock should be the restoration of the organ blood supply, and based on volume resuscitation, dopamine and other vasoactive drugs could be adjunctively used to maintain circulatory stability and could strive for opportunity for etiological treatment for the patients with septic shock.更多还原