The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series
The effects of vasopressin on hemodynamics and renal function in severe septic shock: a case series
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DOI：
10.1007/s001340101014
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发表时间：
2001-08-01
影响因子：
38.9
通讯作者：
Russell, JA
中科院分区：
文献类型：
--
作者：
Holmes, CL;Walley, KR;Russell, JA
目的：回顾所有用加压素治疗的感染性休克病例，以确定对血流动力学和肾功能的影响，并记录任何不良反应。地点：圣保罗医院的 14 个床位混合医疗外科 ICU，这是一家不列颠哥伦比亚大学附属的 450 个床位的三级转诊医院。患者：1997 年 8 月 5 日期间接受加压素治疗严重感染性休克的所有 ICU 患者。和 1999 年 3 月 21 日。结果：我们确定了 50 名患者：年龄 60 (+/- 14)； APACHE II 得分 27 (+/- 7)。将基线数据 (T0) 与输注时 T4、T24 和 T48（4、24 和 48 小时）的数据进行比较。平均动脉压 (MAP) 从 T0 到 T4 增加了 18%，并在 T24 (p = 0.006) 和 T48 (p = 0.008) 保持稳定。肺动脉收缩压 (PAP) 未变化，为 45±13 mmHg。 T4 时平均心脏指数 (CI) 下降 11% (p = 0.03)。 T4 时尿量增加了 79%（p = 0.005），T24 和 T48 时进一步增加并不显着。 T4 时平均升压剂量减少 33% (p = 0.001)，T24 时减少 53% (p = 0.002)，T48 时减少 48% (p = 0.01)。医院死亡率为 85%。有六人心脏骤停；除一例外，其余所有情况均发生在加压素剂量为 0.05 U/min 或更高的情况下。结论：在这组严重感染性休克患者中，输注加压素可增加 MAP 和尿量，并减少儿茶酚胺需求。高于 0.04 U/min 的剂量与有效性增加无关，并且可能与较高的不良反应相关。
Objective: To review all cases of septic shock treated with vasopressin to determine the effects on hemodynamic and renal function and to document any adverse effects.Setting: A 14-bed mixed medical-surgical ICU of St. Paul's Hospital, a 450-bed tertiary referral hospital affiliated with the University of British Columbia.Patients: All ICU patients who received vasopressin for treatment of severe septic shock between August 5, 1997, and March 21, 1999.Results: We identified 50 patients: age 60 (+/- 14); APACHE II score 27 (+/- 7). Baseline data (T0) was compared to data at T4, T24 and T48 (4, 24 and 48 h) on infusion. Mean arterial pressure (MAP) increased by 18 % from T0 to T4 and remained stable at T24 (p = 0.006) and T48 (p = 0.008). Systolic pulmonary artery pressure (PAP) was unchanged at 45 13 mmHg. Mean cardiac index (CI) decreased by 11 % at T4 (p = 0.03). Urine output increased 79 % at T4 (p = 0.005) and further increases were not significant at T24 and T48. Mean pressor dosage decreased by 33 % at T4 (p = 0.001), by 53 % at T24 (p = 0.002) and by 48 % at T48 (p = 0.01). Hospital mortality was 85 %. There were six cardiac arrests; all but one occurred at a vasopressin dose of 0.05 U/min or more.Conclusions: In this group of patients with severe septic shock, vasopressin infusion increased MAP and urine output and decreased catecholamine requirements. Doses higher than 0.04 U/min were not associated with increased effectiveness and may have been associated with higher adverse effects.