Wenzel V, Lindner K H
Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens-University, Anichstrasse 35, 6020, Innsbruck, Austria.
Cardiovasc Res. 2001 Aug 15;51(3):529-41. doi: 10.1016/s0008-6363(01)00262-0.
Epinephrine during cardiopulmonary resuscitation (CPR) is being discussed controversially due to its beta-receptor mediated adverse effects such as increased myocardial oxygen consumption, ventricular arrhythmias, ventilation-perfusion defect, postresuscitation myocardial dysfunction, ventricular arrhythmias and cardiac failure. In the CPR laboratory simulating adult pigs with ventricular fibrillation or postcountershock pulseless electrical activity, vasopressin improved vital organ blood flow, cerebral oxygen delivery, resuscitability, and neurological recovery better than did epinephrine. In paediatric preparations with asphyxia, epinephrine was superior to vasopressin, whereas in both paediatric pigs with ventricular fibrillation, and adult porcine models with asphyxia, combinations of vasopressin and epinephrine proved to be highly effective. This may suggest that a different efficiency of vasopressors in paediatric vs. adult preparations; and different effects of dysrhythmic vs. asphyxial cardiac arrest on vasopressor efficiency may be of significant importance. Whether these theories can be extrapolated to humans is unknown at this point in time. In patients with out-of-hospital ventricular fibrillation, a larger proportion of patients treated with vasopressin survived 24 h compared with patients treated with epinephrine; during in-hospital CPR, comparable short-term survival was found in groups treated with either vasopressin or epinephrine. Currently, a large trial of out-of-hospital cardiac arrest patients being treated with vasopressin vs. epinephrine is ongoing in Germany, Austria and Switzerland. The new CPR guidelines of both the American Heart Association, and European Resuscitation Council recommend 40 U vasopressin intravenously, and 1 mg epinephrine intravenously as equally effective for the treatment of adult patients in ventricular fibrillation; however, no recommendation for vasopressin was made to date for adult patients with asystole and pulseless electrical activity, and paediatrics due to lack of clinical data. When adrenergic vasopressors were unable to maintain arterial blood pressure in patients with vasodilatory shock, continuous infusions of vasopressin ( approximately 0.04 to approximately 0.1 U/min) stabilised cardiocirculatory parameters, and even ensured weaning from catecholamines.
在心肺复苏（CPR）过程中，肾上腺素因其β受体介导的不良反应而备受争议，这些不良反应包括心肌氧耗增加、室性心律失常、通气-灌注缺陷、复苏后心肌功能障碍、室性心律失常和心力衰竭。在模拟成年猪心室颤动或电击后无脉电活动的心肺复苏实验室中，血管加压素在改善重要器官血流、脑氧输送、复苏能力和神经功能恢复方面比肾上腺素更有效。在窒息的儿科实验模型中，肾上腺素优于血管加压素，而在儿科猪心室颤动和成年猪窒息模型中，血管加压素与肾上腺素联合使用被证明非常有效。这可能表明血管加压药在儿科与成年实验模型中的效率不同；心律失常性与窒息性心脏骤停对血管加压药效率的不同影响可能具有重要意义。目前尚不清楚这些理论是否能外推至人类。在院外心室颤动患者中，与接受肾上腺素治疗的患者相比，接受血管加压素治疗的患者中有更大比例存活24小时；在院内心肺复苏期间，接受血管加压素或肾上腺素治疗的组短期存活率相当。目前，德国、奥地利和瑞士正在进行一项关于血管加压素与肾上腺素治疗院外心脏骤停患者的大型试验。美国心脏协会和欧洲复苏委员会的新心肺复苏指南建议，静脉注射40 U血管加压素和静脉注射1 mg肾上腺素对治疗成年心室颤动患者同样有效；然而，由于缺乏临床数据，迄今为止尚未对成年心搏骤停和无脉电活动患者以及儿科患者使用血管加压素提出建议。当肾上腺素能血管加压药无法维持血管扩张性休克患者的动脉血压时，持续输注血管加压素（约0.04至约0.1 U/分钟）可稳定心血管参数，甚至确保停用儿茶酚胺。
