Effects Of Different Doses Of Noradrenaline On Microcirculation In Septic Shock Patients

Objective(s):To observe the effects of different doses of noradrenaline on systemic hemodynamics and microcirculation in septic shock patients.Method(s):Single center,prospective and cohort study.From January 1st,2018 to January 1st,2020,58 patients of septic shock were admitted in the Emergency Intensive Care Unit of First Affiliated Hospital of Kunming Medical University,including31 males and 27 females.After fluid resuscitation,for patients whose central venous pressure(CVP)measured by Central venous catheter reached up to 8 cmH2O,but the mean arterial pressure(MAP)was still lower than 65mmHg,norepinephrine was used.According to the lowest norepinephrine dose that can maintain the mean arterial pressure?65mmHg,the patients were divided into low-dose group(<0.5 ?g/kg/min)and high-dose group(?0.5 ?g/kg/min).The mean arterial pressure(MAP),heart rate(HR)and cardiac index(CI),systemic vascular resistance index(SVRI),CVP were compared before and after treatment in each group,using FDF Microscan(microsee V100 sublingual microcirculation imaging system,Guangzhou medical soft intelligence technology Co.Ltd.)to monitor total vessel density(TVD),perfused vessel density(PVD);proportion of perfused vessels(PPV),microvascular flow index(MFI)and the lactate(LAC)value of arterial blood,calculating ?PPV??MFI2.Results:1.After treatment,MAP and SVRI increased,HR decreased,TVD,PVD and MFI improved in two group;2.? PPV and ? MFI in the low-dose group were close to 0,? PPV and ? MFI in the high-dose group were higher than those in the low-dose group.Conclusion(s):1.When norepinephrine was used in septic shock patients,microcirculatory perfusion improved with the improvement of hemodynamic parameters;2.The microcirculatory perfusion was close to the normal value in the low-dose group after normal hemodynamic parameters;the microcirculatory perfusion improved obviously,but can not restore to normal.after normal hemodynamic parameters.