Intensivist, SSM St. Mary's Hospital, Richmond Heights, St. Louis, United States of America..
Clinical Associate Professor, Critical care/Neurocritical care, Mercy Hospital St.Louis, St. Louis University School of Medicine Program, United States of America.
Am J Emerg Med. 2019 Jun;37(6):1169-1174. doi: 10.1016/j.ajem.2019.03.026. Epub 2019 Mar 19.
Septic shock is a life threatening condition and a medical emergency. It is associated with organ dysfunction and hypotension despite optimal volume resuscitation. Refractory septic shock carries a very high rate of mortality and is associated with ischemic and arrhythmogenic complications from high dose vasopressors. Angiotensin II (AT-II) is a product of the renin-angiotensin-aldosterone system. It is a vasopressor agent that has been recently approved by FDA to be used in conjunction with other vasopressors (catecholamines) in refractory shock and to reduce catecholamine requirements. We have reviewed the physiology and current literature on AT-II in refractory septic/vasodilatory shock. Larger trials with longer duration of follow-up are warranted to address the questions which are unanswered by the ATHOS-3 trial, especially pertaining to its effects on lungs, brain, microcirculation, inflammation, and venous thromboembolism risk.
感染性休克是一种危及生命的病症，也是一种医疗急症。尽管进行了充分的容量复苏，它仍与器官功能障碍和低血压有关。难治性感染性休克的死亡率非常高，并伴有高剂量血管加压素引起的缺血和心律失常并发症。血管紧张素 II (AT-II) 是肾素-血管紧张素-醛固酮系统的产物。它是一种血管加压剂，最近被 FDA 批准与其他血管加压剂（儿茶酚胺）联合用于难治性休克，并降低儿茶酚胺的需求。我们已经回顾了 AT-II 在难治性感染性/血管扩张性休克中的生理学和现有文献。需要进行更大规模、随访时间更长的试验，以解决 ATHOS-3 试验未回答的问题，特别是关于其对肺、脑、微循环、炎症和静脉血栓栓塞风险的影响。
