Jochberger Stefan, Mayr Viktoria D, Luckner Günter, Wenzel Volker, Ulmer Hanno, Schmid Stefan, Knotzer Hans, Pajk Werner, Hasibeder Walter, Friesenecker Barbara, Mayr Andreas J, Dünser Martin W
Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University.
Crit Care Med. 2006 Feb;34(2):293-9. doi: 10.1097/01.ccm.0000198528.56397.4f.
To measure arginine vasopressin (AVP) serum concentrations in critically ill patients.
Prospective study.
Twelve-bed general and surgical intensive care unit in a tertiary, university teaching hospital.
Two-hundred-thirty-nine mixed critically ill patients and 70 healthy volunteers.
None.
Demographic data, hemodynamic variables, vasopressor drug requirements, blood gases, AVP serum concentrations within 24 hrs after admission, multiple organ dysfunction score, and outcome were recorded. Twenty-four hours after admission, study patients had significantly higher AVP concentrations (11.9 +/- 20.6 pg/mL) than healthy controls (0.92 +/- 0.38 pg/mL; p < .001). Males had lower AVP concentrations than females (9.7 +/- 19.5 vs. 15.1 +/- 20.6 pg/mL; p = .014). Patients with hemodynamic dysfunction had higher AVP concentrations than patients without hemodynamic dysfunction (14.1 +/- 27.1 vs. 8.7 +/- 10.8 pg/mL; p = .042). Patients after cardiac surgery (n = 96) had significantly higher AVP concentrations when compared to patients admitted for other diagnoses (n = 143; p < .001). AVP concentrations were inversely correlated with length of stay in the intensive care unit (correlation coefficient, -0.222; p = .002). There was no correlation between serum AVP concentrations and the incidence of shock or specific hemodynamic parameters. Four (1.7%) of the 239 study patients met criteria for an absolute AVP deficiency (AVP, <0.83 pg/mL), and 32 (13.4%) met criteria for a relative AVP deficiency (AVP, <10 pg/mL, and mean arterial pressure, <70 mm Hg). In shock patients, relative AVP deficiency occurred in 22.2% (septic shock), 15.4% (postcardiotomy shock), and 10% (shock due to a severe systemic inflammatory response syndrome) (p = .316).
AVP serum concentrations 24 hrs after intensive care unit admission were significantly increased in this mixed critically ill patient population. The lack of a correlation between AVP serum concentrations and hemodynamic parameters suggests complex dysfunction of the vasopressinergic system in critical illness. Relative and absolute AVP deficiency may be infrequent entities during acute surgical critical illness, mostly remaining without significant effects on cardiovascular function.
测定危重症患者血清中精氨酸加压素（AVP）的浓度。
前瞻性研究。
一所三级大学教学医院的拥有12张床位的普通外科重症监护病房。
239例混合危重症患者和70名健康志愿者。
无。
记录人口统计学数据、血流动力学变量、血管升压药使用需求、血气分析、入院后24小时内的血清AVP浓度、多器官功能障碍评分及转归情况。入院24小时后，研究患者的AVP浓度（11.9±20.6 pg/mL）显著高于健康对照组（0.92±0.38 pg/mL；p<0.001）。男性的AVP浓度低于女性（9.7±19.5 vs. 15.1±20.6 pg/mL；p = 0.014）。存在血流动力学功能障碍的患者AVP浓度高于无血流动力学功能障碍的患者（14.1±27.1 vs. 8.7±10.8 pg/mL；p = 0.042）。心脏手术后患者（n = 96）的AVP浓度显著高于因其他诊断入院的患者（n = 143；p<0.001）。AVP浓度与在重症监护病房的住院时间呈负相关（相关系数，-0.222；p = 0.002）。血清AVP浓度与休克发生率或特定血流动力学参数之间无相关性。239例研究患者中有4例（1.7%）符合绝对AVP缺乏标准（AVP，<0.83 pg/mL），32例（13.4%）符合相对AVP缺乏标准（AVP，<10 pg/mL，且平均动脉压<70 mmHg）。在休克患者中，相对AVP缺乏发生率在脓毒性休克患者中为22.2%，心脏术后休克患者中为15.4%，严重全身炎症反应综合征所致休克患者中为10%（p = 0.316）。
在这组混合危重症患者中，重症监护病房入院24小时后的血清AVP浓度显著升高。AVP血清浓度与血流动力学参数缺乏相关性，提示危重症患者中血管加压素能系统存在复杂功能障碍。相对和绝对AVP缺乏在急性外科危重症期间可能并不常见，大多对心血管功能无显著影响。
