Burton Grant L, Kaufman Jon, Goot Benjamin H, da Cruz Eduardo M
Department of Pediatrics, Section of Pediatric Cardiac Intensive Care, The Children's Hospital, The Heart Institute, Aurora, Colorado, United States of America.
Cardiol Young. 2011 Oct;21(5):536-44. doi: 10.1017/S1047951111000370. Epub 2011 Apr 19.
Following the Norwood palliation, neonates may require an escalation of inotropic and vasoactive support. Arginine Vasopressin may be uniquely useful in supporting this population.
A retrospective evaluation of neonates at this institution between November, 2007 and October, 2010 who received Arginine Vasopressin following the Norwood procedure. Data were recorded from the patient records at one hour prior to, and then 1, 2, 3, 4, 6, and 24 hours following Arginine Vasopressin initiation.
We included 28 neonates. The mean dose of Arginine Vasopressin was 0.0005 plus or minus 0.0003 units per kilogram per minute. There was an early response (less than 6 hours) characterised by an 8% increase in systolic blood pressure (p = 0.0004), a 100% increase in urine output (p = 0.02), and a 29% decrease in total fluid administration (p = 0.04). The late response (at 24 hours) revealed further increases in systolic blood pressure and urine output as well as a 53% decrease in serum lactate (p = 0.007) and increase in arterial pH from 7.36 to 7.45 (p less than 0.0001). These changes were not accompanied by increases in heart rate or inotrope score.
The initiation of Arginine Vasopressin in post-operative Norwood patients was temporally associated with an improvement in markers of perfusion including systolic blood pressure, urine output, lactate, and pH. Further studies are required to ascertain the efficacy of Arginine Vasopressin in this population.
在诺伍德姑息手术后，新生儿可能需要增加正性肌力药和血管活性药物的支持。精氨酸加压素可能对支持这一群体特别有用。
对2007年11月至2010年10月在本机构接受诺伍德手术后使用精氨酸加压素的新生儿进行回顾性评估。在开始使用精氨酸加压素前1小时以及之后1、2、3、4、6和24小时从患者记录中记录数据。
我们纳入了28例新生儿。精氨酸加压素的平均剂量为每分钟每千克0.0005±0.0003单位。早期反应（小于6小时）的特征为收缩压升高8%（p = 0.0004）、尿量增加100%（p = 0.02）以及总液体输入量减少29%（p = 0.04）。晚期反应（24小时时）显示收缩压和尿量进一步升高，血清乳酸降低53%（p = 0.007），动脉血pH值从7.36升至7.45（p < 0.0001）。这些变化并未伴随心率或正性肌力评分的增加。
诺伍德手术后患者开始使用精氨酸加压素与灌注指标的改善在时间上相关，包括收缩压、尿量、乳酸和pH值。需要进一步研究以确定精氨酸加压素在该群体中的疗效。
