Department of Clinical Pharmacy, College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee.
Pharmacotherapy. 2014 Jan;34(1):89-93. doi: 10.1002/phar.1335. Epub 2013 Aug 5.
To evaluate the effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock in patients with acute spinal cord injury (SCI).
Case series.
Academic medical center.
Thirty-eight patients admitted to the trauma intensive care unit between September 2005 and October 2012 with an acute SCI and who received more than 1 day of pseudoephedrine for one or more of the following: treatment of bradycardia (heart rate ≤ 50 beats/min), treatment of hypotension (systolic blood pressure < 90 mm Hg), or were receiving intravenous vasopressor support.
The effect of adjunctive pseudoephedrine (PSE) was categorized as a success if vasopressors were discontinued after the initiation of PSE or improvement in the number of episodes of bradycardia was noted after the initiation of PSE as evidenced by decreased use of atropine. The effect of pseudoephedrine was categorized as a failure if it did not meet one of the criteria for success. The effect of pseudoephedrine was categorized as inconclusive if there were confounding factors such as vasopressors being restarted for another indication after initial discontinuation. Pseudoephedrine was successful in 31/38 (82%) patients, failed in 2/38 (5%) patients, and had inconclusive results in 5/38 (13%) patients. The mean ± SD time to successful weaning of intravenous vasopressors was 7 ± 7 days. Daily maximum pseudoephedrine doses ranged from 60-720 mg. Mean ± SD duration of pseudoephedrine therapy was 32 ± 23 days (range 2-135 days), with 64.5% of surviving patients discharged while receiving pseudoephedrine.
These data suggest that pseudoephedrine is an effective adjunctive therapy in facilitating the discontinuation of intravenous vasopressors and/or atropine in patients with acute SCI with neurogenic shock, although patients will typically require long durations of therapy.
评估伪麻黄碱辅助治疗急性脊髓损伤（SCI）患者神经源性休克的疗效。
病例系列。
学术医疗中心。
2005 年 9 月至 2012 年 10 月期间入住创伤重症监护病房的 38 例急性 SCI 患者，他们接受了 1 天以上的伪麻黄碱治疗，原因如下：治疗心动过缓（心率≤50 次/分）、低血压（收缩压<90mmHg），或正在接受静脉血管加压素支持。
如果在开始使用伪麻黄碱后停用血管加压素，或者在开始使用伪麻黄碱后观察到心动过缓发作次数减少（表现为减少使用阿托品），则将辅助使用伪麻黄碱的效果归类为成功；如果不符合成功标准之一，则将其归类为失败；如果存在重新开始使用血管加压素治疗其他病症等混杂因素，则将其归类为结果不确定。38 例患者中，31 例（82%）成功，2 例（5%）失败，5 例（13%）结果不确定。成功停用静脉血管加压素的平均时间为 7±7 天。每日最大伪麻黄碱剂量为 60-720mg。伪麻黄碱治疗的平均持续时间为 32±23 天（2-135 天），64.5%的存活患者在接受伪麻黄碱治疗的情况下出院。
这些数据表明，伪麻黄碱是一种有效的辅助治疗方法，可促进急性 SCI 伴神经源性休克患者停用静脉血管加压素和/或阿托品，但患者通常需要长时间的治疗。
