Raja Shahzad G, Dreyfus Gilles D
Department of Cardiac Surgery, Harefield Hospital, Middlesex, United Kingdom.
Tex Heart Inst J. 2004;31(4):421-4.
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.
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。
