Low-dose vasopressin in the treatment of vasodilatory septic shock
Low-dose vasopressin in the treatment of vasodilatory septic shock
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DOI：
10.1097/00005373-199910000-00014
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发表时间：
1999-10-01
影响因子：
--
通讯作者：
Townsend, RN
中科院分区：
文献类型：
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作者：
Malay, MB;Ashton, RC;Townsend, RN
背景：尽管采取了适当的治疗，难治性低血压仍常在脓毒性休克中发生，进行了一项双盲安慰剂对照临床试验，以评估低剂量加压素 (VP) 作为升压剂在脓毒性休克中的作用。方法：因血管舒张性脓毒性休克入住创伤重症监护病房的患者被随机分配接受 0.04 U/min 的 VP (n = 5) 或安慰剂 (n = 5)，血管扩张性败血性休克被定义为需要儿茶酚胺药物来维持平均动脉压大于或等于70毫米汞柱，尽管心脏指数大于2.5升/分钟且最小肺动脉楔压大于12毫米汞柱。开始研究药物1小时后，尝试按相应顺序停用去甲肾上腺素、去氧肾上腺素和/或多巴胺，前提是平均动脉压保持不变大于或等于 70 mm Hg。结果：由于外周血管收缩（全身血管阻力从 878 +/- 218 增加到 1,190 +/- 213 dvnes/s/cm(-5)，p < 0.008），输注加压素会增加动脉收缩压（98 +/- 5 至 125 +/- 8 mm Hg，p < 0.008）。 0.05），安慰剂组的动脉压和全身血管阻力在统计学上不受影响，在研究终止前，在药物开始后 24 小时测量，安慰剂组中的两名患者死于顽固性低血压，然而，所有接受 VP 的患者都在 24 小时的研究期间存活下来，并且撤回了所有其他儿茶酚胺升压药，仅通过低剂量 VP 输注维持血压。结论：VP 输注改善了动脉压，并允许戒断儿茶酚胺升压药后，VP 是治疗难治性感染性休克的有效药物。
Background: Despite appropriate therapy, refractory hypotension often occurs in septic shock, A double-blinded placebo controlled clinical trial was performed to assess the role of low-dose vasopressin (VP) as a pressor agent in septic shock.Methods: Patients admitted to a trauma intensive care unit with vasodilatory septic shock were randomized to receive either VP at 0.04 U/min (n = 5) or placebo (n = 5), Vasodilatory septic shock was defined as a need for catecholamine agents to maintain a mean arterial pressure more than or equal to 70 mm Hg, despite a cardiac index more than 2.5 L/min and a minimal pulmonary artery wedge pressure more than 12 mm Hg, After 1 hour of initiation of the study drug, attempts to discontinue norepinephrine, phenylephrine, and/or dopamine, in respective order, were undertaken provided that the mean arterial pressure remained more than or equal to 70 mm Hg.Results: A vasopressin infusion increased systolic arterial pressure (98 +/- 5 to 125 +/- 8 mm Hg, p < 0.008) because of peripheral vasoconstriction (systemic vascular resistance increased from 878 +/- 218 to 1,190 +/- 213 dvnes/s per cm(-5), p < 0.05), Arterial pressure and systemic vascular resistance were statistically unaffected in the placebo group, Before study termination, measured at 24 hours after drug initiation, two patients in the placebo group died of refractory hypotension, However, all patients receiving VP survived the 24-hour study period and had all other catecholamine pressors withdrawn and blood pressure maintained solely with a low-dose VP infusion.Conclusion: A VP infusion improved arterial pressure and permitted the withdrawal of catecholamine vasopressors, VP is a useful agent in the treatment of refractory septic shock.