非体外循环冠状动脉搭桥术后血管麻痹综合征：一种罕见的并发症。
Vasoplegic syndrome after off-pump coronary artery bypass surgery: an unusual complication.
作者信息
Raja Shahzad G, Dreyfus Gilles D
机构信息
Department of Cardiac Surgery, Harefield Hospital, Middlesex, United Kingdom.
出版信息
Tex Heart Inst J. 2004;31(4):421-4.
Abstract
We report the case of a 65-year-old man who developed norepinephrine-resistant vasoplegic syndrome after elective off-pump coronary artery bypass surgery (OPCAB). The failure of norepinephrine to improve the patient's hemodynamics prompted us to start treatment with vasopressin; within 30 minutes, the hemodynamics began to improve. After 12 hours, the patient was stable enough to be weaned from the vasopressin. He was discharged from the hospital on the 10th postoperative day. To our knowledge, ours is the 1st report of vasopressin use for vasodilatory shock after OPCAB in the English-language medical literature. Herein, we discuss the pathophysiology and management of vasoplegic syndrome--which is controversial--with special emphasis on the use of vasopressin in this situation.
摘要
我们报告了一例65岁男性患者，该患者在择期非体外循环冠状动脉搭桥手术（OPCAB）后发生了去甲肾上腺素抵抗性血管麻痹综合征。去甲肾上腺素未能改善患者的血流动力学状况，促使我们开始使用血管加压素进行治疗；在30分钟内，血流动力学状况开始改善。12小时后，患者病情稳定，足以停用血管加压素。患者于术后第10天出院。据我们所知，我们的报告是英文医学文献中关于OPCAB术后使用血管加压素治疗血管舒张性休克的首例报告。在此，我们讨论了存在争议的血管麻痹综合征的病理生理学和管理方法，特别强调了在这种情况下血管加压素的使用。
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本文引用的文献
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Vasopressin therapy for vasoplegic syndrome following cardiopulmonary bypass.
J Card Surg. 2002 Nov-Dec;17(6):485-9. doi: 10.1046/j.1540-8191.2002.01002.x.
2
Vasoplegic syndrome after off-pump coronary artery bypass surgery.
Eur J Cardiothorac Surg. 2003 Feb;23(2):165-9. doi: 10.1016/s1010-7940(02)00734-0.
3
Catastrophic cardiovascular adverse reactions to protamine are nitric oxide/cyclic guanosine monophosphate dependent and endothelium mediated: should methylene blue be the treatment of choice?鱼精蛋白引起的灾难性心血管不良反应依赖一氧化氮/环磷酸鸟苷且由内皮介导：亚甲蓝应作为首选治疗方法吗？
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4
The systemic inflammatory response to cardiac surgery: implications for the anesthesiologist.心脏手术的全身炎症反应：对麻醉医生的启示。
Anesthesiology. 2002 Jul;97(1):215-52. doi: 10.1097/00000542-200207000-00030.
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Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function.
Ann Thorac Surg. 2001 May;71(5):1428-32. doi: 10.1016/s0003-4975(01)02486-9.
6
Reduced expression of systemic proinflammatory cytokines after off-pump versus conventional coronary artery bypass grafting.非体外循环与传统冠状动脉旁路移植术后全身促炎细胞因子表达降低。
Thorac Cardiovasc Surg. 2000 Dec;48(6):364-9. doi: 10.1055/s-2000-8352.
7
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Crit Care Med. 2000 Jan;28(1):249-52. doi: 10.1097/00003246-200001000-00043.
8
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J Trauma. 1999 Oct;47(4):699-703; discussion 703-5. doi: 10.1097/00005373-199910000-00014.
10
Vasoplegic syndrome after open heart surgery.心脏直视手术后的血管麻痹综合征
J Cardiovasc Surg (Torino). 1998 Oct;39(5):619-23.
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