Vasopressin use is associated with death in acute trauma patients with shock
Vasopressin use is associated with death in acute trauma patients with shock
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DOI：
10.1016/j.jcrc.2009.05.003
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发表时间：
2010-03-01
影响因子：
3.7
通讯作者：
Morris, John
中科院分区：
文献类型：
--
作者：
Collier, Bryan;Dossett, Lesly;Morris, John
目的：如果不迅速纠正，创伤性血流动力学不稳定与高死亡率相关。尽管进行了足够的容量复苏，仍出现低血压，可使用血管加压药治疗。虽然儿茶酚胺通常是第一种使用的药物，但精氨酸加压素 (AVP) 越来越多地被用作辅助药物。创伤患者中难治性低血压和使用血管加压素的死亡率尚不清楚。材料和方法：对入院 72 小时内需要血管加压药的创伤患者进行回顾性队列分析。确定了两组：接受 AVP 的患者 (AVP+) 和未接受 AVP 的患者 (AVP-)。主要结局是死亡率。结果：539 名患者符合标准，其中 189 名患者接受 AVP。各组之间的人口统计学、损伤严重程度评分、最低血红蛋白和血容量复苏（浓缩红细胞、新鲜冰冻血浆和血小板）相似。创伤和损伤严重程度评分表明 AVP+ 患者的生存概率较高（0.88 vs 0.73，P < .001）；然而，观察到的死亡率较高（55% vs 41%，P = .002）。 AVP+ 患者的年龄、损伤严重程度评分、初始乳酸和严重头部损伤调整后的死亡比值比为 1.6（95% 置信区间，1.1-2.4；P = 0.02）。 结论：精氨酸加压素与难治性低血压创伤患者死亡率增加相关。精氨酸加压素可能是疾病的标志，或者可能在不良后果中发挥因果作用。临床医生应重新考虑扩大 AVP 使用的适应症。 (C) 2010 Elsevier Inc. 保留所有权利。
Purpose: Traumatic hemodynamic instability is associated with high mortality if not expeditiously corrected. Hypotension despite adequate volume resuscitation is treated with vasopressors. Although catecholamines are typically the first agent used, arginine vasopressin (AVP) is increasingly been used as an adjuvant agent. Mortality with refractory hypotension and vasopressin use in trauma patients is unknown.Materials and Methods: A retrospective cohort analysis of trauma patients requiring vasopressors within 72 hours of admission was performed. Two groups were identified: patients who received AVP (AVP+) and those who did not (AVP-). Primary outcome was mortality.Results: Five hundred thirty nine patients met the criteria with 189 patients receiving AVP. Demographics, Injury Severity Score, minimum hemoglobin, and blood volume resuscitation (packed red blood cell, fresh frozen plasma, and platelets) were similar between groups. Trauma and Injury Severity Score suggested a higher probability of survival in AVP+ (0.88 vs 0.73, P < .001); however, the observed mortality was higher (55% vs 41%, P = .002). The age, Injury Severity Score, initial lactate, and severe head injury adjusted odds ratio of death for AVP+ patients was 1.6 (95% confidence interval, 1.1-2.4; P = .02).Conclusions: Arginine vasopressin is associated with increased mortality in trauma patients with refractory hypotension. Arginine vasopressin may be a marker of illness or possibly play a causal role in adverse outcomes. Clinicians should reconsider expanding the indications of AVP use. (C) 2010 Elsevier Inc. All rights reserved.