Lavigne Dominique
Institut Universitaire De Cardiologie Et De Pneumologie de Quebec, Canada.
Semin Cardiothorac Vasc Anesth. 2010 Sep;14(3):186-9. doi: 10.1177/1089253210379271.
Cardiac surgery with cardiopulmonary bypass (CPB) is frequently complicated by vasoplegic syndrome, a vasodilatory shock state. Traditional treatment based on fluid resuscitation and catecholamine drugs is ineffective in a number of patients. Clinical trials investigating both vasopressin and methylene blue as additional rescue or preventative therapy are reviewed. Vasopressin is suggested to retain its vasoconstrictive power in hypoxemia and acidosis, lower pulmonary hypertension, reduce supraventricular arrhythmias, and accelerate intensive care unit (ICU) recovery. Safety concerns include frequent thrombocytopenia and potentially altered mesenteric and renal perfusion. Methylene blue is suggested to facilitate CPB weaning, reduce renal, respiratory, arrhythmic, and septic complications, reduce mortality, and accelerate ICU and hospital recovery. Safety concerns include oximeter interference, pulmonary hypertension, neurotoxicity, arrhythmias, and potentially altered coronary, mesenteric, and renal perfusion. Research on both molecules is ongoing and has yet to confirm on a larger scale their efficacy and safety as treatments for post-CPB vasoplegic syndrome.
体外循环（CPB）心脏手术常并发血管麻痹综合征，即一种血管扩张性休克状态。在许多患者中，基于液体复苏和儿茶酚胺类药物的传统治疗方法无效。本文综述了将血管加压素和亚甲蓝作为额外的抢救或预防性治疗的临床试验。血管加压素被认为在低氧血症和酸中毒时仍保留其血管收缩能力，可降低肺动脉高压，减少室上性心律失常，并加速重症监护病房（ICU）康复。安全问题包括频繁发生血小板减少症以及可能改变肠系膜和肾脏灌注。亚甲蓝被认为有助于CPB撤机，减少肾脏、呼吸、心律失常和感染并发症，降低死亡率，并加速ICU和医院康复。安全问题包括干扰血氧饱和度测定、肺动脉高压、神经毒性、心律失常以及可能改变冠状动脉、肠系膜和肾脏灌注。对这两种药物的研究仍在进行中，尚未在更大规模上证实它们作为CPB后血管麻痹综合征治疗方法的疗效和安全性。
