Iliopoulos Ilias, Flores Saul, Pratap J N, Cooper David S, Cassedy Amy, Nelson David P
1Cardiac Intensive Care Unit,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
2Heart Institute Research Core,Cincinnati Children's Hospital Medical Center,Heart Institute,Cincinnati,Ohio,United States of America.
Cardiol Young. 2017 Aug;27(6):1031-1040. doi: 10.1017/S104795111600189X. Epub 2016 Dec 14.
We hypothesised that infants with ventricular dysfunction after cardiac surgery have impaired haemodynamic response to arginine-vasopressin therapy. We retrospectively reviewed the medical records of neonates and infants treated with arginine-vasopressin within 48 hours of corrective or palliative cardiac surgery who underwent echocardiographic assessment of ventricular function before initiation of therapy. Patients were classified as "responders" if their systolic blood pressure increased by ⩾10% without increase in catecholamine score or if it was maintained with decreased catecholamine score. Response was assessed 1 hour after maximum upward titration of arginine-vasopressin. A total of 36 children (15 neonates) were reviewed (17 male). The median (interquartile) age was 10.4 weeks (1.1-26.9), and the median weight was 4.3 kg (3.2-5.8). Diagnoses included single ventricle (eight), arch abnormalities (five), atrioventricular septal defect (four), double-outlet right ventricle (three), tetralogy of Fallot (three), and others (13). In all, 12 patients (33%) had ventricular dysfunction. Only 15 (42%) responded favourably according to our definition 1 hour after the "target" arginine-vasopressin dose was achieved. Ventricular dysfunction was not associated with poor response. The overall mortality was 25%, but mortality in patients with ventricular dysfunction was 42%. Favourable response was associated with shorter ICU stay (9.5 days versus 19.5 days, p=0.01). We conclude that arginine-vasopressin fails to increase blood pressure in ~50% of hypotensive children after cardiac surgery. The response rate does not increase with duration of therapy. Ventricular function does not predict haemodynamic response. The mortality in this group is very high. Prospective comparison of vasopressin with other vasoactive agents and/or inotropes is warranted.
我们假设心脏手术后出现心室功能障碍的婴儿对精氨酸加压素治疗的血流动力学反应受损。我们回顾性分析了在进行矫正或姑息性心脏手术后48小时内接受精氨酸加压素治疗的新生儿和婴儿的病历，这些患儿在开始治疗前接受了心室功能的超声心动图评估。如果患者的收缩压升高≥10%且儿茶酚胺评分未增加，或者收缩压在儿茶酚胺评分降低的情况下维持不变，则将其分类为“反应者”。在精氨酸加压素最大剂量上调后1小时评估反应情况。共纳入36例儿童（15例新生儿）进行分析（17例男性）。年龄中位数（四分位间距）为10.4周（1.1 - 26.9），体重中位数为4.3 kg（3.2 - 5.8）。诊断包括单心室（8例）、主动脉弓畸形（5例）、房室间隔缺损（4例）、右心室双出口（3例）、法洛四联症（3例）及其他（13例）。总共有12例患者（33%）存在心室功能障碍。在达到“目标”精氨酸加压素剂量1小时后，根据我们的定义，只有15例（42%）反应良好。心室功能障碍与反应不佳无关。总体死亡率为25%，但心室功能障碍患者的死亡率为42%。良好的反应与较短的重症监护病房住院时间相关（9.5天对19.5天，p = 0.01）。我们得出结论，约50%的心脏手术后低血压儿童使用精氨酸加压素后血压未能升高。反应率不会随着治疗时间的延长而增加。心室功能无法预测血流动力学反应。该组患者的死亡率非常高。有必要对加压素与其他血管活性药物和/或正性肌力药物进行前瞻性比较。
