Original Article

Effects of norepinephrine, epinephrine, and norepinephrine-dobutamine on systemic and gastric mucosal oxygenation in septic shock.

Authors: Shao-Xia ZHOU, Hai-Bo QIU, Ying-Zi HUANG, Yi YANG, Rui-Qiang ZHENG

Abstract

AIM: To compare the effects of dopamine, norepinephrine, epinephrine, and the
combination of norepinephrine and dobutamine on systemic and gastric mucosal
oxygen metabolism in patients with septic shock.
METHODS: Sixteen patients with septic shock were enrolled in the present study.
Each patient received dopamine firstly, then in a random succession epinephrine,
norepinephrine, or norepinephrine-dobutamine, a mean systemic arterial pressure
adjusted to >9.31 kPa. After 120 min of each treatment, hemodynamic, oxygen
metabolic, and gastric mucosal parameters were obtained.
RESULTS: Epinephrine induced a significant increase in heart rate compared with
other three groups (P <0.05), and a significant higher cardiac index compared
with norepinephrine alone and norepinephrine-dobutamine (P <0.05). Oxygen
extraction ratio values were lower with epinephrine infusion as compared with
other three groups (P <0.05). Arterial lactate concentrations decreased
significantly with norepinephrine-dobutamine as compared with dopamine and
epinephrine infusions (P <0.05). As compared with epinephrine infusion, the
gastric intramucosal pH values were higher with norepinephrine-dobutamine
infusion (7.25+/-0.09 vs 7.14+/-0.07, P <0.05).
CONCLUSION: Dopamine, norepinephrine, epinephrine, or norepinephrine-dobutamine
improved blood pressure. Epinephrine and dopamine had deleterious effect on
oxygen metabolism, while norepinephrine plus low dose of dobutamine improved
gastric mucosal perfusion and tissue oxygen utilization.
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