Wenzel Volker, Krismer Anette C, Arntz H Richard, Sitter Helmut, Stadlbauer Karl H, Lindner Karl H
Department of Anesthesiology and Critical Care Medicine, Leopold-Franzens University, Innsbruck, Austria.
N Engl J Med. 2004 Jan 8;350(2):105-13. doi: 10.1056/NEJMoa025431.
Vasopressin is an alternative to epinephrine for vasopressor therapy during cardiopulmonary resuscitation, but clinical experience with this treatment has been limited.
We randomly assigned adults who had had an out-of-hospital cardiac arrest to receive two injections of either 40 IU of vasopressin or 1 mg of epinephrine, followed by additional treatment with epinephrine if needed. The primary end point was survival to hospital admission, and the secondary end point was survival to hospital discharge.
A total of 1219 patients underwent randomization; 33 were excluded because of missing study-drug codes. Among the remaining 1186 patients, 589 were assigned to receive vasopressin and 597 to receive epinephrine. The two treatment groups had similar clinical profiles. There were no significant differences in the rates of hospital admission between the vasopressin group and the epinephrine group either among patients with ventricular fibrillation (46.2 percent vs. 43.0 percent, P=0.48) or among those with pulseless electrical activity (33.7 percent vs. 30.5 percent, P=0.65). Among patients with asystole, however, vasopressin use was associated with significantly higher rates of hospital admission (29.0 percent, vs. 20.3 percent in the epinephrine group; P=0.02) and hospital discharge (4.7 percent vs. 1.5 percent, P=0.04). Among 732 patients in whom spontaneous circulation was not restored with the two injections of the study drug, additional treatment with epinephrine resulted in significant improvement in the rates of survival to hospital admission and hospital discharge in the vasopressin group, but not in the epinephrine group (hospital admission rate, 25.7 percent vs. 16.4 percent; P=0.002; hospital discharge rate, 6.2 percent vs. 1.7 percent; P=0.002). Cerebral performance was similar in the two groups.
The effects of vasopressin were similar to those of epinephrine in the management of ventricular fibrillation and pulseless electrical activity, but vasopressin was superior to epinephrine in patients with asystole. Vasopressin followed by epinephrine may be more effective than epinephrine alone in the treatment of refractory cardiac arrest.
在心肺复苏期间，血管加压素可作为肾上腺素进行血管升压治疗的替代药物，但这种治疗的临床经验有限。
我们将院外心脏骤停的成年人随机分组，分别接受两次注射40国际单位血管加压素或1毫克肾上腺素治疗，必要时追加肾上腺素治疗。主要终点是入院存活，次要终点是出院存活。
共有1219例患者接受随机分组；33例因研究药物编码缺失而被排除。在其余1186例患者中，589例被分配接受血管加压素治疗，597例接受肾上腺素治疗。两个治疗组的临床特征相似。在心室颤动患者中，血管加压素组和肾上腺素组的入院率无显著差异（46.2%对43.0%，P = 0.48）；在无脉电活动患者中也无显著差异（33.7%对30.5%，P = 0.65）。然而，在心脏停搏患者中，使用血管加压素的入院率（29.0%）显著高于肾上腺素组（20.3%；P = 0.02），出院率也更高（4.7%对1.5%，P = 0.04）。在732例接受两次研究药物注射后未恢复自主循环的患者中，追加肾上腺素治疗使血管加压素组的入院存活率和出院存活率显著提高，而肾上腺素组未提高（入院率，25.7%对16.4%；P = 0.002；出院率，6.2%对1.7%；P = 0.002）。两组的脑功能相似。
在心室颤动和无脉电活动的治疗中，血管加压素的效果与肾上腺素相似，但在心脏停搏患者中，血管加压素优于肾上腺素。血管加压素后追加肾上腺素在治疗难治性心脏骤停方面可能比单独使用肾上腺素更有效。
