Application Of Norepinephrine In Cardiogenic Shock

Objective:To explore the advantages of norepinephrine in the application of cardiac shock(CS)by comparing with dopamine.Methods: 122 patients with cardiogenic shock were selected from The first people's Hospital of Hefei City and Hefei Binhu Hospital.They were randomly divided into dopamine(dopamine,DA)group(n = 58)and noradrenaline(norepinephrine,NE)group(n = 64).There was no significant difference in age,sex and underlying diseases between the two groups.All patients were accepted after proper routine treatment.Routine treatment including fluid management,maintenance of water and electrolyte balance,auxiliary ventilation,reperfusion of myocardial infarction to improve cardiac function,etc.The two groups were given 5~20?g/(kg ? min)dopamine and 0.05~2.0?g/(kg ? min),norepinephrine respectively.The mortality rates of intensive care department,hospitalization,28 days and 6 months were compared between the two groups.And the changes of mean arterial pressure(MAP)urine volume and lactate level ?heart rate(HR),were compared between the two groups after 4 hours?8hours and 24 hours of medication.The incidence of total arrhythmia and different types of arrhythmias were compared between the two groups.And the clinical efficacy index of the two groups including time spent in ICU,time in hospital,IABP usage ratio,time for MAP to reach 70 mmHg,time without organ support and gastrointestinal adverse reactions.Results:(1)The mortality rates of intensive care,hospitalization and 28 days in NE group were 23.4%,35.9% and 46.9%,respectively,which were lower than those in DA group(43.1%,55.1%,65.5%).(P < 0.05).There was no difference in the mortality rateof 6 months(NE group 69.0%VSDA group53.1%)(P>0.05).(2)After treatment,the heart rate of the patients in both groups decreased with time.In DA group,the heart rate increased in the early stage(in first 4 hours)but decreased in the later stage.In NE group the heart rate was lower at the beginning of treatment.Heart rate in DA group was significantly higher than that in NE group at the same time after treatment(P < 0.05).At 4 h,8 h,24 h,the improvement of CI in NE group was significantly better than that in dopamine group.(P < 0.05).MAP in DA group and NE group was higher than that before treatment,and MAP in NE group was higher than that in DA group at the same time point(P < 0.05).The lactate level of NE group was lower than that of DA group at the same time.The urine volume of NE group was more than that of DA group at the same time point(P < 0.05).(3)There was no significant difference in BNP and LVEF between NE group and DA group before treatment(P > 0.05).After 48 hours of treatment,the BNP and LEVF in NE group were significantly higher than those in DA group.The decrease of BNP in NE group was significantly higher than that in DA group(P < 0.05).After 48 hours of treatment,LVEF in NE group was higher than that in DA group(P < 0.05).(4)The number of arrhythmia events in DA group is higher than that in NE group,especially atrial fibrillation(DA31.0%,NE12.5%)was lower in NE group(P < 0.05).There was no significant difference in the incidence of ventricular tachycardia and ventricular fibrillation between the two groups(P>0.05).(5)The duration of ICU hospitalization in NE group was shorter than that in DA group and low IABP usage rate in NE group(P < 0.05).When MAP reaches 70 mmHg,NE takes less time(P < 0.05).The incidence of gastrointestinal adverse reactions in NE group is lower than that in DA group(P < 0.05).The time of mechanical ventilation and the proportion of use,no need of organ support time,there was no significant difference between the two groups(P>0.05).Conclusion:(1)NE can stabilize hemodynamics in patients with CS at the early stage,improve perfusion of tissues and organs.(2)NE reduces mortality within a certain period of time and has fewer side effects.(3)NE is more suitable for cardiogenic shock than DA,and should be used as the first choice.