摘要 脓毒症作为全球关注的公共卫生问题,是重症监护病房(intensive care unit,ICU)患者死亡的主要原因之一,进一步发展可致脓毒性休克,住院死亡率达40.4%。血管活性药物的早期、正确、合理使用,在一定程度上可以显著降低脓毒症或脓毒性休克的死亡率。脓毒症血管活性药物主要包括去甲肾上腺素、血管加压素、肾上腺素、多巴酚丁胺、多巴胺和去氧肾上腺素等。在脓毒症血管活性药物选择上,首选去甲肾上腺素,对于去甲肾上腺素及相关剂量难以有效的患者,可加用血管加压素或肾上腺素;对于心动过缓患者可考虑使用多巴胺。早期单独使用适量的去甲肾上腺素,或联用适量的血管加压素、肾上腺素、多巴酚丁胺,可有效地逆转顽固性低血压,从而恢复组织器官的有效灌注,同时需强调时机与剂量的重要性。此外,根据病情变化的不同阶段,选择适合患者病情的液体复苏,适时调整血管活性药物的类型和剂量,使受损器官及系统功能逐渐改善,患者平稳度过危险阶段。本文针对脓毒症血管活性药物的选择作一简要综述。
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