The Comparative Study About Dopamine And Norepinephrine In The Treatment Of Septic Shock

Background:Septic shock is a common clinical syndrome and has a high mortality rate due to multiple organ failure, which is currently the main cause of death in ICU. In recent years, considerable progress has been made in anti-infective therapy and organ support technology, however, the mortality rate of septic shock is still as high as30%～70%, and is expected to reach934,000～1,110,000cases in2010to2020. Therefore, reducing mortality from septic shock is a urgent challenge for critical care physidans worldwidely. worldwide.The early stage of septic shock is characterized by high-output and low-resistance hemodynamics and can lead to sustained hypotension and hypoperfusion of tissues and organs. Refractory shock is the leading cause of death in ICU patients, accounting for about50%of ICU deaths. When the blood pressure is not maintained in shock patients even after aggressive fluid resuscitation, vasoactive drugs should be administered to maintain adequate arterial blood pressure and oxygen transport and ensure splanchnic perfusion and tissue oxygenation. Norepinephrine and dopamine are used for the first-line clinical treatment of septic shock; however, there has been great dispute amongst clinicians regarding the most effective vasoactive drug. Purpose:To compare the efficacy of dopamine and norepinephrine for the treatment of septic shock patients.Subjects:Patients admitted to the ICU department in Ningbo University Hospital due to septic shock after abdominal surgery from October2009to February2012were chosen for this study.Method:1. The indusive206cases of patients who developed septic shock after abdominal surgery were randomly divided into dopamine(DA) and norepinephrine(NE) treatment groups for the anti-hypotension treatment.2. The following hemodynamic parameters of both groups of patients were compared at four time points,that is:before administration (To), and at lhr (T1),3h (T3) and6h (T6) intervals after administration:mean arterial blood pressure (MAP), heart rate (HR), pulmonary capillary wedge pressure (PCWP), cardiac output index (CI), systemic vascular resistance index (SVRI).3. The following oxygen metabolism indicators of both groups of patients were compared at four time points, namely before drug administration (To), and at1h (T1),3h (T3) and6h (T6) intervals after administration:oxygen delivery index (DO2I), oxygen consumption index (VO2I), oxygen uptake rate (O2ext), lactate clearance rate and mixed venous oxygen saturation(SvO2) 4. For both groups, the recovery rate after6h and the mortality rate after28days were compared.Results:1. SVRI and CI in the NE group were significantly higher while HR was significantly lower than the control at To, P<0.05;2.AT To.the VO2I and O2ext was significantly higher for patients in the NE group while the DO2I was significantly lower than the control group, P<0.05. When comparing the lactate clearance rate and SvO2, the ratio of lactate clearance to SvO2≥65%for the NE group was significantly higher than that for the control group, P<0.05.3. The recovery after6h was higher in patients of the NE group, P<0.05.Conclusion:1. The septic shock patients treated with norepinephrine had greater success rate of recovery after6h.2. Norepinephrine is better than dopamine to maintain the hemodynamic status of the septic shock patients and improve tissue oxygenation. Moreover, the improvement in systemic vascular resistance index and oxygen uptake rate is also more obvious.3. Norepinephrine is more suitable for the treatment of septic shock and is worthy of clinical application.