Mastropietro Christopher W, Clark Jeff A, Delius Ralph E, Walters Henry L, Sarnaik Ashok P
Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA. cmastropmed.wayne.edu
Pediatr Crit Care Med. 2008 Sep;9(5):506-10. doi: 10.1097/PCC.0b013e3181849ce0.
Management of patients with single ventricle physiology following stage I palliation procedures is often challenging, with optimization of the ratio of pulmonary-to-systemic blood flow as an important goal. Persistent hypoxemia may be a manifestation of elevated pulmonary vascular resistance and therefore decreased blood flow to the lungs. In such situations, the use of arginine vasopressin to increase systemic vascular resistance may be an effective strategy to improve pulmonary blood flow and maintain adequate pulmonary-to-systemic blood flow ratio. We describe three infants in whom persistent hypoxemia improved after institution of arginine vasopressin.
Retrospective chart review.
Twenty-four bed medical-surgical pediatric intensive care unit at a large tertiary care academic hospital.
Three neonates with single ventricle physiology who received arginine vasopressin in the setting of hypoxemia following stage I palliation.
Arginine vasopressin was initiated in all three patients for hypoxemia with a goal to increase systemic vascular resistance and generate a higher driving pressure for pulmonary blood flow. Twelve hours after arginine vasopressin initiation, systemic arterial saturation as determined by pulse oximetry and blood pressure increased, whereas heart rate, inotrope score, and Fio2 decreased in all three patients. Urine output was maintained and arterial lactate decreased during this time. Pulmonary-to-systemic flow ratio increased in one patient in whom it could be determined.
In patients with single ventricle physiology and persistent hypoxemia following stage I palliation, administration of arginine vasopressin could improve oxygenation possibly by increasing systemic vascular resistance and therefore the pulmonary blood flow.
对接受一期姑息手术的单心室生理患儿进行管理往往具有挑战性，优化肺循环与体循环血流比值是一个重要目标。持续性低氧血症可能是肺血管阻力升高的表现，进而导致肺血流减少。在这种情况下，使用精氨酸加压素增加体循环血管阻力可能是改善肺血流并维持适当肺循环与体循环血流比值的有效策略。我们描述了3例使用精氨酸加压素后持续性低氧血症得到改善的婴儿。
回顾性病历审查。
一家大型三级医疗学术医院的24张床位的儿科内科-外科重症监护病房。
3例单心室生理的新生儿，在一期姑息治疗后出现低氧血症时接受了精氨酸加压素治疗。
所有3例患者均因低氧血症开始使用精氨酸加压素，目标是增加体循环血管阻力并为肺血流产生更高的驱动压力。开始使用精氨酸加压素12小时后，通过脉搏血氧饱和度测定法测定的体循环动脉血氧饱和度和血压升高，而所有3例患者的心率、血管活性药物评分和吸入氧分数降低。在此期间尿量维持稳定，动脉血乳酸水平下降。在1例能够测定的患者中，肺循环与体循环血流比值增加。
对于一期姑息治疗后出现单心室生理和持续性低氧血症的患者，给予精氨酸加压素可能通过增加体循环血管阻力从而增加肺血流来改善氧合。
