1. 一般考虑先输液。如果在充分的液体复苏之前使用血管加压药,效果较差,而且可能导致器官灌注不足。心源性休克是个例外,在这种情况下必须谨慎使用液体。基于循证的血管加压药: 2. 简化方法始终使用您的临床判断!◆ 感染性休克 – 去甲肾上腺素。◆ 心源性休克 – 去甲肾上腺素。◆ 没有明显低血压的失代偿性心力衰竭——考虑多巴酚丁胺。◆ 过敏性休克 – 肾上腺素 IM。3. 起始剂量 Keywords: vasopressors, hypotension, norepinephrine, vasopressin, epinephrine Beale RJ, Hollenberg SM, Vincent JL, et al. Vasopressor and inotropic support in septic shock: an evidence based review. Crit Care Med 2004;32:S455-465. Bellomo R, Chapman M, Finfer S, et al. Low-dose dopamine in patients with early renal dysfunction: a placebo-controlled randomised trial. Lancet 2000;356:2139-2143. De Backer D, Aldecoa C, Njimi H, Vincent JL. Dopamine versus norepinephrine in the treatment of septic shock: a metaanalysis. Crit Care Med 2012;40:725-30. De Backer D, Devriendt, J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med 2010; 362:779. Myburgh JA, et al. A comparison of epinephrine and norepinephrine in critically ill patients. Intensive Care Med 2008;34:2226-34. Russell JA, Walley KR, Singer J, et al. Vasopressin versus norepinephrine infusion in patients with septic shock. N Engl J Med 2008;358:877-87.