Nishibe Shinichi, Tsujita Miki
Department of Anesthesiology, Saitama International Medical Center, Saitama, Japan.
Interact Cardiovasc Thorac Surg. 2012 Dec;15(6):966-72. doi: 10.1093/icvts/ivs396. Epub 2012 Sep 7.
Although recent advances have led to a better understanding of the beneficial effects of vasopressin on haemodynamics in paediatric cardiac surgery, not much information is available on the adverse effects. The objective of this study was to assess the impact of intraoperative vasopressin infusion on postoperative liver, renal and haemostatic function and lactate levels in neonates undergoing cardiac surgery.
We reviewed data from 34 consecutive neonates who had undergone complex cardiac surgery. The cohort was divided into two groups according to the use of vasopressin. Seventeen patients received vasopressin [vasopressin (+) group], and 17 patients did not [vasopressin (-) group].
No differences between the groups in terms of age, weight, cardiopulmonary bypass time, Risk Adjustment for Congenital Heart Surgery-1 score or the comprehensive Aristotle score were seen. No differences in the systolic or diastolic arterial blood pressures, heart rate or inotropic score upon admission to the intensive care unit were observed between the groups. No adverse effects on the aminotransferase levels were seen. The vasopressin (+) group had higher urea and creatinine levels. All the patients except one received peritoneal dialysis on the day of surgery. Thirteen patients in the vasopressin (+) group and 7 patients in the vasopressin (-) group continued to require peritoneal dialysis on postoperative day 5 (POD 5) (P = 0.04). The platelet count had decreased to a significantly lower level in the vasopressin (+) group on POD 5 [97 x 10(3)/mm(3) (range: 40-132 x 10(3)/mm(3))]. A tendency toward a high lactate concentration was seen in the vasopressin (+) group. In comparison with the vasopressin (-) group, the number of patients whose lactate level remained above 2.0 mmol/l was higher in the vasopressin (+) group on PODs 2 and 3 (17 patients vs 8 patients, P < 0.01 and 15 patients vs 7 patients, P = 0.01, respectively).
These findings suggest that the intraoperative use of vasopressin extends the period of peritoneal dialysis, reduces platelet counts and delays the recovery of the lactate concentration. Intraoperative vasopressin infusion should not be used routinely, but only in catecholamine-refractory shock.
尽管最近的进展使人们对血管加压素在小儿心脏手术中对血流动力学的有益作用有了更好的理解，但关于其不良反应的信息却不多。本研究的目的是评估术中输注血管加压素对接受心脏手术的新生儿术后肝脏、肾脏、止血功能及乳酸水平的影响。
我们回顾了34例连续接受复杂心脏手术的新生儿的数据。根据血管加压素的使用情况将队列分为两组。17例患者接受了血管加压素治疗[血管加压素（+）组]，17例患者未接受治疗[血管加压素（-）组]。
两组在年龄、体重、体外循环时间、先天性心脏病手术风险调整-1评分或综合亚里士多德评分方面均无差异。两组进入重症监护病房时的收缩压或舒张压、心率或肌力评分均无差异。未观察到对转氨酶水平有不良反应。血管加压素（+）组的尿素和肌酐水平较高。除1例患者外，所有患者均在手术当天接受了腹膜透析。血管加压素（+）组13例患者和血管加压素（-）组7例患者在术后第5天（POD 5）仍需腹膜透析（P = 0.04）。在POD 5时，血管加压素（+）组的血小板计数显著降低至较低水平[97×10³/mm³（范围：40 - 132×10³/mm³）]。血管加压素（+）组有乳酸浓度升高的趋势。与血管加压素（-）组相比，血管加压素（+）组在POD 2和POD 3时乳酸水平仍高于2.0 mmol/l的患者数量更多（分别为17例对8例，P < 0.01；15例对7例，P = 0.01）。
这些发现表明，术中使用血管加压素会延长腹膜透析时间，降低血小板计数并延迟乳酸浓度的恢复。术中不应常规使用血管加压素输注，仅在儿茶酚胺难治性休克时使用。
