Treschan Tanja A, Peters Jürgen
Klinik für Anästhesiologie und Intensivmedizin, Germany.
Anesthesiology. 2006 Sep;105(3):599-612; quiz 639-40. doi: 10.1097/00000542-200609000-00026.
Vasopressin, synthesized in the hypothalamus, is released by increased plasma osmolality, decreased arterial pressure, and reductions in cardiac volume. Three subtypes of vasopressin receptors, V1, V2, and V3, have been identified, mediating vasoconstriction, water reabsorption, and central nervous system effects, respectively. Vasopressin and its analogs have been studied intensively for the treatment of states of "relative vasopressin deficiency," such as sepsis, vasodilatory shock, intraoperative hypotension, and cardiopulmonary resuscitation. Infusion of vasopressin (0.01-0.04 U/min) decreases catecholamine requirements in patients with sepsis and other types of vasodilatory shock. Bolus application of 1 mg terlipressin, the V1 agonist, reverses refractory hypotension in anesthetized patients and has been studied in patients with septic shock and chronic liver failure. During cardiopulmonary resuscitation, a 40-U bolus dose of vasopressin may be considered to replace the first or second bolus of epinephrine regardless of the initial rhythm. The side effects of vasopressin and its analogs must be further characterized.
血管加压素在下丘脑合成，当血浆渗透压升高、动脉血压降低和血容量减少时释放。已确定血管加压素受体有三种亚型，即V1、V2和V3，分别介导血管收缩、水重吸收和中枢神经系统效应。血管加压素及其类似物已被深入研究用于治疗“相对血管加压素缺乏”状态，如脓毒症、血管扩张性休克、术中低血压和心肺复苏。输注血管加压素（0.01 - 0.04 U/分钟）可降低脓毒症和其他类型血管扩张性休克患者对儿茶酚胺的需求。静脉推注1毫克特利加压素（V1激动剂）可逆转麻醉患者的顽固性低血压，并且已在感染性休克和慢性肝功能衰竭患者中进行研究。在心肺复苏期间，无论初始心律如何，可考虑给予40 U静脉推注剂量的血管加压素以替代第一或第二次肾上腺素推注。血管加压素及其类似物的副作用必须进一步明确。
