目的 探討去甲腎上腺素聯(lián)合多巴胺在感染中毒性休克液體復(fù)蘇中的作用。方法 采用回顧性研究方法，選擇2015年2月—2018年1月在榆林市星元醫(yī)院ICU診治的144例感染中毒性休克患者作為研究對象，根據(jù)治療方法的不同分為觀察組74例與對照組70例。兩組都給予充分液體復(fù)蘇，對照組給予多巴胺輔助治療，觀察組給予去甲腎上腺素聯(lián)合多巴胺輔助治療，記錄兩組6 h復(fù)蘇率與28 d死亡率，記錄兩組治療前與治療3 d后的心率（HR）、混合靜脈血氧飽和度（SvO₂）、尿量、內(nèi)生肌酐清除率及白介素-4（IL-4）、白介素-10（IL-10）。結(jié)果 觀察組的6 h復(fù)蘇率與28 d死亡率分別為70.3%和24.3%，對照組分別為47.1%和47.1%，兩組比較差異具有統(tǒng)計學(xué)意義（P<0.05）。兩組治療后的SvO₂都顯著高于治療前，且觀察組高于對照組，差異均有統(tǒng)計學(xué)意義（P<0.05）；觀察組治療后的HR低于治療前，也低于對照組，差異均有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組的尿量與內(nèi)生肌酐清除率都顯著高于治療前，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且觀察組高于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。治療后，兩組血清IL-4和IL-10水平都顯著低于治療前，同組治療前后比較差異有統(tǒng)計學(xué)意義（P<0.05）；且觀察組低于對照組，差異有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 去甲腎上腺素聯(lián)合多巴胺在感染中毒性休克液體復(fù)蘇中的應(yīng)用能抑制炎癥因子的釋放，改善患者的腎功能與血氣指標(biāo)，從而提高復(fù)蘇率與降低死亡率。

Objective To investigate the effects of norepinephrine combined with dopamine on fluid resuscitation in septic shock. Methods Retrospective study method was adopted, patients (144 cases) with septic shock in Xingyuan Hospital of Yulin from February 2015 to January 2018 were selected and were divided into observation group (74 cases) and control group (70 cases) according to the different treatment methods. The two groups were given full fluid resuscitation, the control group received dopamine-assisted therapy, and the observation group received norepinephrine combined with dopamine-assisted therapy. Resuscitation rate at 6 h and mortality rate at 28 d were recorded in the two groups, as well as HR, SvO₂, urine volume, endogenous creatinine scavenging rate, IL-4 and IL-10 before and after treatment were recorded in the two groups. Results The 6 h recovery rate and 28 d mortality rate in the observation group were 70.3% and 24.3%, respectively, and the control group were 47.1% and 47.1%, respectively, and compard the difference were statistically significantly (P<0.05). After treatment, the SvO₂ in two groups were significantly higher than that before the treatment, and the observation group were higher than control group (P<0.05), the HR in the observation group were lower than that before the treatment, and were lower than the control group, compared the difference were statistically significantly (P<0.05). After treatment, the urine volume and the endogenous creatinine clearance rate were significantly higher than those before treatment (P<0.05), and the observation group were higher than the control group, and compared the difference was statistically significantly (P<0.05). After treatment, the levels of serum IL-4 and IL-10 in two groups were significantly lower than that before the treatment (P<0.05), and the observation group were lower than the control group (P<0.05). Conclusion The application of norepinephrine combined with dopamine in the fluid resuscitation of toxic shock can inhibit the release of inflammatory factors, improve the renal function and blood gas index of patients, so as to improve the resuscitation rate and reduce the mortality.