Departments of Pediatrics, Chirayu Medical College and Hospital, Bhopal, MP, India.
Indian Pediatr. 2012 Apr;49(4):297-305. doi: 10.1007/s13312-012-0046-0.
Reports of successful use of vasopressin in various shock states and cardiac arrest has lead to the emergence of vasopressin therapy as a potentially major advancement in the management of critically ill children.
To provide an overview of physiology of vasopressin, rationale of its use and dose schedule in different disease states with special focus on recent advances in the therapeutic applications of vasopressin.
MEDLINE search (1966-September 2011) using terms vasopressin, terlipressin, arginine-vasopressin, shock, septic shock, vasodilatory shock, cardiac arrest, and resuscitation for reports on vasopressin/terlipressin use in children and manual review of article bibliographies. Search was restricted to human studies. Randomized controlled trials, cohort studies, evaluation studies, case series, and case reports on vasopressin/terlipressin use in children (preterm neonates to 21 years of age) were included. Outcome measures were analysed using following clinical questions: indication, dose and duration of vasopressin/terlipressin use, main effects especially on systemic blood pressure, catecholamine requirement, urine output, serum lactate, adverse effects, and mortality.
51 reports on vasopressin (30 reports) and terlipressin (21 reports) use in pediatric population were identified. A total of 602 patients received vasopressin/terlipressin as vasopressors in various catecholamine-resistant states (septic - 176, post-cardiotomy - 136, other vasodilatory/mixed shock - 199, and cardiac arrest - 101). Commonly reported responses include rapid improvement in systemic blood pressure, decline in concurrent catecholamine requirement, and increase in urine output; despite these effects, the mortality rates remained high.
In view of the limited clinical experience, and paucity of randomized controlled trials evaluating these drugs in pediatric population, currently no definitive recommendations on vasopressin/terlipressin use can be laid down. Nevertheless, available clinical data supports the use of vasopressin in critically ill children as a rescue therapy in refractory shock and cardiac arrest.
血管加压素在各种休克状态和心脏骤停中的成功应用报告导致了血管加压素治疗作为危重病儿童管理的潜在重大进展的出现。
提供血管加压素生理学概述，其在不同疾病状态下使用的原理和剂量方案，特别关注血管加压素治疗应用的最新进展。
使用术语血管加压素、特利加压素、精氨酸血管加压素、休克、感染性休克、血管扩张性休克、心脏骤停和复苏，对儿童血管加压素/特利加压素使用的报告进行 MEDLINE 搜索（1966 年-2011 年 9 月），并手动审查文章参考文献。搜索仅限于人类研究。纳入了儿童（早产儿至 21 岁）使用血管加压素/特利加压素的随机对照试验、队列研究、评估研究、病例系列和病例报告。使用以下临床问题分析结果测量：适应症、血管加压素/特利加压素使用的剂量和持续时间、主要影响，特别是全身血压、儿茶酚胺需求、尿量、血清乳酸、不良反应和死亡率。
确定了 51 篇关于儿科人群血管加压素（30 篇报告）和特利加压素（21 篇报告）使用的报告。共有 602 名患者接受了血管加压素/特利加压素作为各种儿茶酚胺抵抗状态（感染性 - 176、心脏手术后 - 136、其他血管扩张性/混合性休克 - 199、心脏骤停 - 101）的血管加压剂。常报道的反应包括全身血压迅速改善、同时儿茶酚胺需求下降和尿量增加；尽管有这些效果，死亡率仍然很高。
鉴于临床经验有限，并且缺乏评估这些药物在儿科人群中的随机对照试验，目前无法对血管加压素/特利加压素的使用提出明确建议。然而，现有的临床数据支持将血管加压素作为危重病儿童的抢救治疗，用于难治性休克和心脏骤停。
