Mastropietro Christopher W, Davalos Maria C, Seshadri Shivaprakash, Walters Henry L, Delius Ralph E
Division of Critical Care, Department of Pediatrics, Wayne State University/Children's Hospital of Michigan, Detroit, Michigan 48201, USA.
Cardiol Young. 2013 Jun;23(3):387-93. doi: 10.1017/S1047951112000996. Epub 2012 Jul 18.
To describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response. Materials and Methods We reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.
Of the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.
Arginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.
描述心脏手术后因血流动力学不稳定而接受精氨酸加压素治疗的儿童的血流动力学反应，并确定与良好反应相关的临床变量。材料与方法：我们回顾了2009年1月至2010年7月在我院接受心脏直视手术且术后7天内接受精氨酸加压素治疗的6岁及以下患者。良好反应者定义为血压升高或维持且儿茶酚胺评分降低，或在开始使用精氨酸加压素后6小时血压升高幅度大于或等于基线的10%且儿茶酚胺评分未改变的患者。
在确定的34例患者中，17例（50%）对精氨酸加压素有良好反应。6小时时，反应者的平均血压升高了32.2%，而非反应者升高了4.6%，p值小于0.001。反应者的平均儿茶酚胺评分降低了30.1%，非反应者升高了7.6%，p值小于0.001。两组的人体测量学、人口统计学和术中变量相似，精氨酸加压素的最大剂量也相似。然而，开始使用精氨酸加压素时到达重症监护病房后的中位时间，反应者较晚，为20小时，而未反应者为6小时，p值等于0.032。
在本研究中，精氨酸加压素治疗仅使一半的儿童血流动力学得到改善，且如果在术后夜间后开始使用精氨酸加压素，改善更有可能发生。
