目的    对比研究多巴胺（DA）和去甲肾上腺素（NE）对感染性休克病人血流动力学和组织氧代谢的影响。方法    2009年10月至2012年2月于宁波大学医学院附属医院重症医学科住院治疗的腹部外科手术后感染性休克病人206例，随机等分为DA组（采用DA治疗）和NE组（采用NE治疗）进行抗休克集束化治疗。分别比较两组病人给药前（T0）及给药后第1小时（T1）、第3小时（T3）和第6小时（T6）4个时间点的血流动力学指标包括平均动脉压（MAP）、心率（HR）、心脏指数（CI）和全身血管阻力指数（SVRI），组织氧代谢指标包括氧供指数（DO2）、氧耗指数（VO2）、氧摄取率（O2ext）、乳酸清除率和混合静脉血氧饱和度（SvO2），并比较两组病人6 h复苏成功率。结果    NE组病人6 h复苏成功率明显高于DA组（P<0.05）。NE组SVRI在T3、T6点明显高于DA组（P<0.01）；HR在T1、T3和T6点均明显低于DA组，而CI则明显高于DA组（P<0.01）。NE组VO2、O2 ext在T3、T6点高于DA组，而DO2则明显低于DA组（P<0.01)。NE较DA能明显提高乳酸清除率（P<0.05）和SvO2≥70%的比例（P<0.01）。结论    NE较DA能更加有效、快速地改善感染性休克病人血流动力学状态和组织氧代谢，提高液体复苏成功率。

Comparison of dopamine and norepinephrine in the treatment of septic shock        WANG Shan-shan*，CUI Wei. *Intensive Care Unit，the Second Affiliated Hospital，Zhejiang University School of Medicine，Hangzhou 310009，China
Corresponding author：CUI Wei，E-mail：iamcuiwei@aliyun.com
Abstract    Objective    To compare the effects of dopamine (DA) and norepinephrine (NE) on hemodynamics and oxygen metabolism in the treatment of septic shock. Methods    Two hundreds and six patients with septic shock secondary to abdominal surgery from October 2009 to February 2012 in Intensive Care Unit, Second Affiliated Hospital were randomized to DA group and NE group，and underwent the bundle therapy against septic shock. On admission (T0)，and at 1 h(T1)，3 h(T3)  and 6 h (T6) after treatment，hemodynamic parameters including the mean artery pressure (MAP)，heart rate (HR)，cardiac index (CI) , systemic vascular resistance index (SVRI)， tissue oxygenation parameters including oxygen delivery (DO2)，oxygen consumption (VO2)，oxygen extraction ratio (O2ext)，mixed venous blood oxygen saturation (SvO2) and lactate clearance were detected and compared between the two groups. The success rate of 6 hr-fluid resuscitation was also compared between the two groups. Results    The NE group had significantly higher 6 hr-fluid resuscitation rate compared to DA group (P<0.05). In comparison with DA group，SVRI in NE group was significantly elevated at T3 and T6 time-points (all P<0.01). HR decreased and CI increased significantly at T1，T3 and T6 time-points (all P<0.01). At T3 and T6 time-points，VO2 and O2 ext in NE group were significantly higher，while DO2 was significantly lower compared with those in DA group (all P<0.01). NE significantly increased lactate clearance (P<0.05) and the ratio of SvO2≥65% (P<0.01). Conclusion    NE is more effective than DA in the treatment of septic shock and mediates faster improvement of hemodynamic status and tissue oxygen metabolism. NE offers higher success rate of fluid resuscitation against septic shock.