Wieruszewski Patrick M, Nei Scott D, Maltais Simon, Schaff Hartzell V, Wittwer Erica D
From the Departments of Pharmacy.
Cardiovascular Surgery.
A A Pract. 2018 Aug 15;11(4):96-99. doi: 10.1213/XAA.0000000000000752.
Cardiac vasoplegia remains a significant contributor of morbidity and mortality in cardiac surgery patients after cardiopulmonary bypass. Effective therapeutic options for vasopressor-refractory vasoplegia are limited. We report 3 patients in whom we administered high-dose intravenous ascorbic acid (vitamin C), a cofactor for endogenous catecholamine synthesis, to treat vasoplegia refractory to epinephrine, vasopressin, and norepinephrine after surgery requiring cardiopulmonary bypass. Reductions in vasopressor requirements were observed in all 3 patients, and, in 2 patients, norepinephrine was completely discontinued within 24 hours. Ascorbic acid is a novel potential therapeutic option for cardiac vasoplegia that warrants rigorous prospective studies.
心脏麻痹仍然是心脏手术患者体外循环后发病和死亡的重要原因。对于血管升压药难治性心脏麻痹，有效的治疗选择有限。我们报告了3例患者，在需要体外循环的手术后，我们给予高剂量静脉注射抗坏血酸（维生素C），一种内源性儿茶酚胺合成的辅助因子，以治疗对肾上腺素、血管加压素和去甲肾上腺素难治的心脏麻痹。所有3例患者的血管升压药需求均减少，其中2例患者在24小时内完全停用了去甲肾上腺素。抗坏血酸是一种治疗心脏麻痹的新型潜在治疗选择，值得进行严格的前瞻性研究。
