Cardiac performance during vasopressin infusion in postcardiotomy shock
Cardiac performance during vasopressin infusion in postcardiotomy shock
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DOI：
10.1007/s00134-002-1265-y
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发表时间：
2002-06-01
影响因子：
38.9
通讯作者：
Hasibeder, WR
中科院分区：
文献类型：
--
作者：
Dünser, MW;Mayr, AJ;Hasibeder, WR
目的：精氨酸-血管加压素（AVP）可能是一种有效的血管加压剂，用于治疗儿茶酚胺抵抗性心切术后休克，但由于考虑到其对心脏的有害影响，其使用仍处于实验阶段。我们报道了持续输注avp对心脏功能、心肌缺血生物标志物和儿茶酚胺抵抗性心切术后休克的全身血流动力学的影响。设计：回顾性研究。环境：21个床位的普通和外科重症监护室。患者：41例儿茶酚胺耐药性心切术后休克。干预措施：持续输注AVP。测量与结果：采集AVP开始输注前及开始输注后1、4、12、24、48 h的心率（HR）、心律、平均动脉压（MAP）、中心静脉压、平均肺动脉压、心脏指数（CI）、脑卒中容积指数（SVI）、左室卒中工作指数（LVSWI）、全身血管阻力（SVR）及米力酮和去甲肾上腺素需氧量。每日测定血清肌酸激酶MB和肌钙蛋白i浓度。在AVP给药期间，我们观察到HR（-14.8%）和米立酮（-17.5%）显著降低。和去甲肾上腺素需求（-54.9%）以及心脏缺血的生物标志物和LVSWI显著增加（+46.2%）。MAP（+41.8%）和SVR（+60%）。Cl和SVI保持不变。术后45%的新发心动过速（TA）在AVP输注期间转化为窦性心律。结论：AVP对儿茶酚胺耐药心切术后休克患者无不良影响。HR、血管加压素和肌力支持的显著降低表明心肌功能的显著改善。这些发现得到了45.5%新发TA患者心肌酶显著降低和TA心律转复为窦性心律的支持。
Objective: Arginine-vasopressin (AVP) might be a potent vasopressor agent in catecholamine-resistant postcardiotomy shock, However, its use remains experimental because of considerations about deleterious effects on the heart. We report on the effects of continuous AVP-infusion on cardiac performance, biomarkers of myocardial ischemia, and systemic hemodynamics in catecholamine-resistant postcardiotomy shock. Design: Retrospective study. Setting: Twenty-one-bed general and surgical intensive care unit. Patients: Forty-one patients with catecholamine-resistant postcardiotomy shock. Interventions: Continuous infusion of AVP. Measurements and results: Heart rate (HR), heart rhythm, mean arterial pressure (MAP), central venous pressure, mean pulmonary arterial pressure, cardiac index (CI), stroke volume index (SVI), left ventricular stroke work index (LVSWI), systemic vascular resistance (SVR) as well as milrinone and norepinephrine requirements were collected before and 1, 4, 12, 24, and 48 h after start of AVP infusion. Creatine kinase MB and troponin-I serum concentrations were measured daily. During AVP administration we observed a significant decrease in HR (-14.8%), milrinone (-17.5%). and norepinephrine requirements (-54.9%) as well as biomarkers of cardiac ischemia and a significant increase in LVSWI (+46.2%). MAP (+41.8%) and SVR (+60%). Cl and SVI remained unchanged. Forty-five percent of postoperative new-onset tachyarrhythmias (TA) converted into sinus rhythm during AVP infusion. Conclusions: AVP was devoid of adverse effects on the heart in these patients with catecholamine-resistant postcardiotomy shock. The significant reduction in HR, vasopressor, and inotropic support suggest a substantial improvement in myocardial performance. These findings are supported by a significant decrease of cardiac enzymes and cardioversion of TA into sinus rhythm in 45.5% of patients with new-onset TA.