Bussard Rachel L, Busse Laurence W
Critical Care Pharmacy Specialist, Department of Pharmacy, Emory St Joseph's Hospital, Atlanta, GA, USA.
Department of Critical Care, Emory St Joseph's Hospital, Atlanta, GA, USA,
Ther Clin Risk Manag. 2018 Jul 26;14:1287-1298. doi: 10.2147/TCRM.S150434. eCollection 2018.
Angiotensin II (Ang II), part of the renin-angiotensin-aldosterone system (RAS), is a potent vasoconstrictor and has been recently approved for use by the US Food and Drug Administration in high-output shock. Though not a new drug, the recently published Angiotensin II for the Treatment of High Output Shock (ATHOS-3) trial, as well as a number of retrospective analyses have sparked renewed interest in the use of Ang II, which may have a role in treating refractory shock. We describe refractory shock, the unique mechanism of action of Ang II, RAS dysregulation in shock, and the evidence supporting the use of Ang II to restore blood pressure. Evidence suggests that Ang II may preferentially be of benefit in acute kidney injury and acute respiratory distress syndrome, where the RAS is known to be disrupted. Additionally, there may be a role for Ang II in cardiogenic shock, angiotensin converting enzyme inhibitor overdose, cardiac arrest, liver failure, and in settings of extracorporeal circulation.
血管紧张素II（Ang II）是肾素-血管紧张素-醛固酮系统（RAS）的一部分，是一种强效血管收缩剂，最近已获美国食品药品监督管理局批准用于治疗高输出量性休克。尽管不是新药，但最近发表的血管紧张素II治疗高输出量性休克（ATHOS-3）试验以及一些回顾性分析引发了人们对使用Ang II的新兴趣，其可能在治疗难治性休克中发挥作用。我们描述了难治性休克、Ang II独特的作用机制、休克时RAS的失调以及支持使用Ang II恢复血压的证据。有证据表明，Ang II可能在急性肾损伤和急性呼吸窘迫综合征中特别有益，已知在这些疾病中RAS会被破坏。此外，Ang II在心源性休克、血管紧张素转换酶抑制剂过量、心脏骤停、肝衰竭以及体外循环情况下可能也有作用。
