PICU, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Surgery Department, Pediatric Cardiac Center, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Shock. 2018 Aug;50(2):173-177. doi: 10.1097/SHK.0000000000001051.
Although the use of vasopressin has become commonplace in pediatric patients with vasodilatory shock after cardiac surgery, its efficacy and hemodynamic effects have not been systematically documented. Furthermore, previous studies were mainly limited patients with left heart anomalies. To date, the use of vasopressin in patients with right heart anomalies has not yet been reported. To clarify the hemodynamic effects of vasopressin on pediatric patients with vasodilatory shock after cardiopulmonary bypass, 70 consecutive patients, most of whom with right heart anomalies, were retrospectively analyzed in Fuwai Hospital from October 2013 to September 2015. Vasopressin was administered continuously at a dose of 0.0002 to 0.002 u/kg/min. Hemodynamics, urine output, and catecholamine vasopressor doses were compared before and after vasopressin initiation. Results showed that besides the significant increase in blood pressure at 2 h after vasopressin administration, the systemic vascular resistance index also prominently elevated from 894.3 ± 190.8 dyn/s to 1138.2 ± 161.4 dyn/s per cm per m, while the heart rate, right atrial pressure, pulmonary artery pressure had a trend of decline. Subsequently, the fluid requirement, the catecholamine vasopressor requirement both decreased and urine output increased. Lactate concentration showed a later remarkable decline at 12 h since vasopressin administration. All the 70 patients survived to hospital discharge. In conclusion, low dose of vasopressin administration was associated with great and timely hemodynamic improvement for pediatric patients with vasodilatory shock after cardiac surgery without any significant adverse effects.
虽然血管加压素在心脏手术后并发血管扩张性休克的儿科患者中已被广泛应用，但它的疗效和血流动力学效应尚未得到系统的记录。此外，之前的研究主要局限于左心畸形患者。迄今为止，尚未有报道血管加压素在右心畸形患者中的应用。为了阐明血管加压素对体外循环后并发血管扩张性休克的儿科患者的血流动力学效应，我们回顾性分析了 2013 年 10 月至 2015 年 9 月阜外医院的 70 例连续患者，这些患者大多存在右心畸形。血管加压素以 0.0002 至 0.002 u/kg/min 的剂量持续输注。比较了血管加压素起始前后的血流动力学、尿量和儿茶酚胺血管加压素剂量。结果表明，除了血管加压素给药后 2 小时血压显著升高外，全身血管阻力指数也从 894.3±190.8 增加到 1138.2±161.4 dyn/s/cm/m，而心率、右心房压、肺动脉压呈下降趋势。随后，液体需求和儿茶酚胺血管加压素需求减少，尿量增加。血管加压素给药后 12 小时乳酸浓度显著下降。所有 70 例患者均存活至出院。总之，小剂量血管加压素治疗与心脏手术后并发血管扩张性休克的儿科患者的及时且显著的血流动力学改善相关，没有任何明显的不良反应。
