Morales D L, Gregg D, Helman D N, Williams M R, Naka Y, Landry D W, Oz M C
Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York 10032, USA.
Ann Thorac Surg. 2000 Jan;69(1):102-6. doi: 10.1016/s0003-4975(99)01197-2.
The barroreflex-mediated secretion of arginine vasopressin has been found to be defective in a variety of vasodilatory shock states, such as postcardiotomy shock, and administration of the hormone markedly improves vasomotor tone and blood pressure. The high incidence of vasodilatory shock in patients undergoing left ventricular assist device (LVAD) implantation makes this population an ideal model in which to assess the risks and benefits of vasopressin.
The medical records of the 102 patients receiving LVADs at Columbia-Presbyterian Medical Center from January 1995 to August 1998 were reviewed. Fifty patients were eligible for study based on a history of arginine vasopressin administration in the operating room or intensive care unit within 24 hours of implantation.
Despite LVAD implantation and the administration of vasopressors, patients were hypotensive with a mean arterial pressure less than 60 mm Hg. The administration of vasopressin (0.09+/-0.05 U/min) increased mean arterial pressure (58+/-13 to 75+/-14 mm Hg; p<0.001) while reducing norepinephrine administration (11.7+/-13 to 7.9+/-6.0 mcg/min; p = 0.023). There was no significant change in LVAD flow. The incidence of compromised regional perfusion was not different between LVAD patients who received vasopressin as compared to hemodynamically stable LVAD patients who did not receive vasopressin.
We have demonstrated vasopressin at low doses to be a safe and an effective vasopressor in 50 patients with postcardiotomy vasodilatory shock.
在多种血管舒张性休克状态下，如心脏术后休克，已发现压力感受性反射介导的精氨酸血管加压素分泌存在缺陷，而给予该激素可显著改善血管运动张力和血压。接受左心室辅助装置（LVAD）植入的患者中血管舒张性休克的发生率很高，这使得该人群成为评估血管加压素风险和益处的理想模型。
回顾了1995年1月至1998年8月在哥伦比亚长老会医学中心接受LVAD治疗的102例患者的病历。50例患者因在植入后24小时内在手术室或重症监护病房接受过精氨酸血管加压素治疗而符合研究条件。
尽管植入了LVAD并使用了血管加压药，但患者仍处于低血压状态，平均动脉压低于60 mmHg。给予血管加压素（0.09±0.05 U/分钟）可提高平均动脉压（从58±13 mmHg升至75±14 mmHg；p<0.001），同时减少去甲肾上腺素的用量（从11.7±13 μg/分钟降至7.9±6.0 μg/分钟；p = 0.023）。LVAD血流量无显著变化。接受血管加压素的LVAD患者与未接受血管加压素且血流动力学稳定的LVAD患者相比，局部灌注受损的发生率无差异。
我们已证明低剂量血管加压素对50例心脏术后血管舒张性休克患者是一种安全有效的血管加压药。
