THE EFFECTS OF NOREPINEPHRINE ON HEMODYNAMICS AND RENAL-FUNCTION IN SEVERE SEPTIC SHOCK STATES

被引:130
作者
REDLWENZL, EM [1 ]
ARMBRUSTER, C [1 ]
EDELMANN, G [1 ]
FISCHL, E [1 ]
KOLACNY, M [1 ]
WECHSLERFORDOS, A [1 ]
SPORN, P [1 ]
机构
[1] KRANKENANSTALT RUDOLFSTIFTUNG WIEN,DEPT SURG 1,A-1030 VIENNA,AUSTRIA
关键词
VASOACTIVE DRUGS; NOREPINEPHRINE; SEPSIS; HEMODYNAMIC; HYPERDYNAMIC SHOCK;
D O I
10.1007/BF01720530
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To investigate the effect of norepinephrine (NE) on hemodynamics, oxygen metabolism and renal function in patients with severe septic shock. Design: Prospective study. Setting: Post-operative ICU in a municipal general hospital. Patients: The study included 56 patients with extreme low resistance states due to abdominal sepsis, who remained hypotensive (MAP < 60 mmHg) despite optimal fluid therapy and dopamine > 20 mug/kg/min and cumulative doses of dopamine and dobutamine > 30 mug/kg/min, respectively. Interventions: After registration of baseline values dopamine was reduced to 2.5 mug/kg/min, and norepinephrine was administered starting at a dose of 0.05 mug/kg/min until a mean arterial pressure of more than 60 mmHg could be maintained. Measurements and results: During norepinephrine infusion (dosage ranging between 0.1-2 mug/kg/min, mean dose rate: 0.4 mug/kg/min) mean arterial pressure and systemic vascular resistance index increased significantly (p < 0.001). After 8 h a significant increase in stroke volume (p < 0.05) and decrease in heart rate (p < 0.05) could be observed. There was no significant change in cardiac index (CI), oxygen delivery, (O2AVI) and oxygen consumption (VO2I). Creatinine clearance increased significantly (p < 0.005) from a control value of 75 +/- 37 ml/min to 102 +/- 43 ml/min after 48 h NE-treatment. Conclusion: Our results suggest that norepinephrine can be used safely in the treatment of severe septic shock states. Mean arterial pressure and glomerular filtration rate improved markedly without deleterious effects on CI, O2AVI and VO2I.
引用
收藏
页码:151 / 154
页数:4
相关论文
共 25 条
[1]   SEQUENTIAL CARDIORESPIRATORY PATTERNS IN SEPTIC SHOCK [J].
ABRAHAM, E ;
SHOEMAKER, WC ;
BLAND, RD ;
COBO, JC .
CRITICAL CARE MEDICINE, 1983, 11 (10) :799-803
[2]   OXYGEN DELIVERY AND CONSUMPTION IN PATIENTS WITH HYPERDYNAMIC SEPTIC SHOCK [J].
ASTIZ, ME ;
RACKOW, EC ;
FALK, JL ;
KAUFMAN, BS ;
WEIL, MH .
CRITICAL CARE MEDICINE, 1987, 15 (01) :26-28
[3]  
BAUMGARTNER JD, 1984, INTENS CARE MED, V10, P245
[4]   SEPSIS SYNDROME - A VALID CLINICAL ENTITY [J].
BONE, RC ;
FISHER, CJ ;
CLEMMER, TP ;
SLOTMAN, GJ ;
METZ, CA ;
BALK, RA .
CRITICAL CARE MEDICINE, 1989, 17 (05) :389-393
[5]   PATHOGENIC MECHANISMS IN EARLY NOREPINEPHRINE-INDUCED ACUTE RENAL-FAILURE - FUNCTIONAL AND HISTOLOGICAL CORRELATES OF PROTECTION [J].
CRONIN, RE ;
TORRENTE, AD ;
MILLER, PD ;
BULGER, RE ;
BURKE, TJ ;
SCHRIER, RW .
KIDNEY INTERNATIONAL, 1978, 14 (02) :115-125
[6]   A REAPPRAISAL OF NOREPINEPHRINE THERAPY IN HUMAN SEPTIC SHOCK [J].
DESJARS, P ;
PINAUD, M ;
POTEL, G ;
TASSEAU, F ;
TOUZE, MD .
CRITICAL CARE MEDICINE, 1987, 15 (02) :134-137
[7]   USE OF SURVIVORS CARDIORESPIRATORY VALUES AS THERAPEUTIC GOALS IN SEPTIC SHOCK [J].
EDWARDS, JD ;
BROWN, GCS ;
NIGHTINGALE, P ;
SLATER, RM ;
FARAGHER, EB .
CRITICAL CARE MEDICINE, 1989, 17 (11) :1098-1103
[8]  
GROENEVELD ABJ, 1986, SURGERY, V99, P140
[9]   LOW-DOSE NOREPINEPHRINE IN PATIENTS WITH SEPTIC SHOCK AND OLIGURIA - EFFECTS ON AFTERLOAD, URINE FLOW, AND OXYGEN-TRANSPORT [J].
HESSELVIK, JF ;
BRODIN, B .
CRITICAL CARE MEDICINE, 1989, 17 (02) :179-180
[10]   APACHE-II - A SEVERITY OF DISEASE CLASSIFICATION-SYSTEM [J].
KNAUS, WA ;
DRAPER, EA ;
WAGNER, DP ;
ZIMMERMAN, JE .
CRITICAL CARE MEDICINE, 1985, 13 (10) :818-829