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.