Notaro Salvatore, Sorrentino Marcello, Ruocco Aniello, Notaro Annalisa, Corcione Antonio, Murino Patrizia, Piscitelli Eugenio, Tamborino Marianna
Intensive Care Unit, AORN dei colli Vincenzo Monaldi Hospital, Naples, Italy.
Intensive Care Unit, Fatebenefratelli Hospital, Naples, Italy.
J Med Case Rep. 2017 Nov 13;11(1):320. doi: 10.1186/s13256-017-1456-3.
In this article, we present a clinical case of refractory septic shock resulting from intestinal perforation treated with high doses of vasopressin and hydrocortisone during emergency surgery. The use of such high doses of vasopressin for this type of shock is not described in the literature.
A 49-year-old white woman with grade III obesity, Crohn's disease, and an intestinal perforation presented with refractory septic shock. Initially, a low dose of vasopressin was used. Then, the dosage was increased to 0.4 U/minute; in the literature, this is defined as "salvage therapy." This therapy consists of an initial load followed by a continuous infusion of hydrocortisone.
The significant increase in her cardiac index and stroke volume index resulted in an improvement in peripheral resistance, gas exchange, and urine output and a decrease in her heart rate, interleukin-6 level, and tumor necrosis factor-α level. The administration of high doses of vasopressin and corticosteroids was demonstrated to be safe for the immune system, to reduce the systemic inflammatory response, and to have direct cardiovascular effects. Further studies are required to examine the use of vasopressin as an initial vasopressor as well as its use in high dosages and in combination with corticosteroids.
在本文中，我们介绍了一例因肠穿孔导致的难治性感染性休克的临床病例，该病例在急诊手术期间接受了高剂量血管加压素和氢化可的松治疗。文献中未描述将如此高剂量的血管加压素用于此类休克的情况。
一名49岁的白人女性，患有III级肥胖症、克罗恩病和肠穿孔，出现难治性感染性休克。最初使用了低剂量的血管加压素。然后，剂量增加至0.4 U/分钟；在文献中，这被定义为“挽救治疗”。该治疗包括初始负荷剂量，随后持续输注氢化可的松。
她的心脏指数和每搏输出量指数显著增加，导致外周阻力、气体交换和尿量改善，心率、白细胞介素-6水平和肿瘤坏死因子-α水平降低。高剂量血管加压素和皮质类固醇的给药被证明对免疫系统安全，可减轻全身炎症反应，并具有直接的心血管作用。需要进一步研究血管加压素作为初始血管升压药的使用情况，以及其高剂量使用和与皮质类固醇联合使用的情况。
