Vasopressin therapy for vasoplegic syndrome following cardiopulmonary bypass
Vasopressin therapy for vasoplegic syndrome following cardiopulmonary bypass
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DOI：
10.1046/j.1540-8191.2002.01002.x
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发表时间：
2002-11-01
影响因子：
1.6
通讯作者：
Kouchoukos, NT
中科院分区：
文献类型：
--
作者：
Masetti, P;Murphy, SF;Kouchoukos, NT
背景采用心肺转流术（CPB）的心脏手术后最大剂量α-肾上腺素能药物难治性低血压被称为“血管麻痹综合征"。“血管加压素已被用于其治疗，取得了令人鼓舞的结果。材料和方法：16例患者（平均年龄71岁，范围47 - 84岁）在接受采用CPB的复杂心脏手术后，静脉注射血管加压素（0.1-1 IU/min）治疗最大剂量（>30 μ g/kg/min）去甲肾上腺素难治性低血压。术前射血分数为40.5%（平均值，范围20%-60%），术前NYHA分级为3.5（平均值）。在开始加压素输注前1小时和输注后1小时进行血流动力学测量;在开始输注前4小时和输注后4小时测量尿量。加压素治疗持续时间为58.8 +/- 37.3小时（平均值+/- SD）。结果如下：收缩压从89.6 +/- 7.9升高至119.6 +/- 10.5 mmHg（平均值+/- SD）（p < 0.001）;全身血管阻力从688.0 +/- 261.7增加到1043.3 +/- 337.1 dyne/s/cm（2）（平均值+/- SD）（p < 0.001）;心脏指数从2.69 +/- 0.8降至2.2 +/- 0.5 L/min/m（2）（平均值+/- SD）（P < 0.008）;尿量从36.8 +/- 30.4 mL/h增加至72.8 +/- 38.2 mL/h（平均值+/- SD）（p < 0.001）。7例患者（44%）在住院期间存活。结论：大剂量血管加压素对体外循环心脏手术后血管麻痹综合征的治疗是有效的。
Background. Hypotension refractory to maximal doses of alpha-adrenergic drugs after cardiac operations employing cardiopulmonary bypass (CPB) has been referred as "vasoplegic syndrome." Vasopressin has been used for its therapy with encouraging results. Material and methods: 16 patients (mean age 71, range 47 to 84 years) were treated with intravenous vasopressin (0.1-1 IU/min) for hypotension refractory to maximal doses (>30 mug/kg/min) of norepinephrine after undergoing complex cardiac operations employing CPB. Preoperative ejection fraction was 40.5% (mean, range 20% to 60%), preoperative NYHA class was 3.5 (mean). Hemodynamic measurements were obtained one hour before and one hour after beginning vasopressin infusion; urine output was measured for the 4 hours before and the 4 hours after beginning the infusion. Duration of vasopressin treatment was 58.8 +/- 37.3 hours (mean +/- SD). Results: Systolic blood pressure increased from 89.6 +/- 7.9 to 119.6 +/- 10.5 mmHg (mean +/- SD) (p < 0.001); systemic vascular resistance increased from 688.0 +/- 261.7 to 1043.3 +/- 337.1 dyne/s/cm(2) (mean +/- SD) (p < 0.001); cardiac index decreased from 2.69 +/- 0.8 to 2.2 +/- 0.5 L/min/m(2) (mean +/- SD) (P < 0.008); urine output increased from 36.8 +/- 30.4 to 72.8 +/- 38.2 mL/h (mean +/- SD) (p < 0.001). Seven patients (44%) survived the hospital stay. Conclusions: High-dose vasopressin is effective in the treatment of the vasoplegic syndrome after cardiac operations employing cardiopulmonary bypass.