Division of Cardiology, Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin; Division of Critical Care, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Ann Thorac Surg. 2019 Dec;108(6):1865-1874. doi: 10.1016/j.athoracsur.2019.06.053. Epub 2019 Aug 7.
Arginine vasopressin is a nonapeptide hormone with effects on intracellular water transport and arterial tone that is used in distributive shock and following cardiopulmonary bypass. We sought to evaluate the safety and efficacy of vasopressin infusion on hemodynamics and fluid balance in the early postoperative period after Fontan completion.
We conducted a randomized, double-blinded, placebo-controlled study of vasopressin infusion for 24 hours after cardiopulmonary bypass for Fontan completion. Patient characteristics, hospital outcomes, and measures of hemodynamic parameters, urine output, chest tube drainage, fluid balance, laboratory data, and plasma arginine vasopressin concentrations were collected at baseline and for 48 postoperative hours. Data were analyzed using mixed-effect regressions.
Twenty patients were randomized, 10 to vasopressin and 10 to placebo. Transpulmonary gradient (6.4 ± 0.5 vs 8.3 ± 0.5 mm Hg, P = .011) and chest tube drainage (23 ± 20 vs 40 ± 20 mL/kg, P = .028) for 48 hours after surgery were significantly lower in the vasopressin arm compared to placebo. Arginine vasopressin concentrations were elevated above baseline after surgery until 4 hours post cardiac intensive care unit admission in both arms, and higher in the vasopressin arm during postoperative infusion. No differences in sodium concentration, liver function, or renal function were noted between groups.
Vasopressin infusion after Fontan completion appears safe and was associated with reduced transpulmonary gradient and chest tube drainage in the early postoperative period. A larger multiinstitutional study may show further outcome benefit.
精氨酸加压素是一种九肽激素，对细胞内水转运和动脉张力有影响，用于分布性休克和心肺旁路手术后。我们旨在评估加压素输注在法洛四联症根治术后早期对血流动力学和液体平衡的安全性和有效性。
我们进行了一项随机、双盲、安慰剂对照的研究，比较心肺旁路手术后 24 小时内加压素输注与安慰剂对法洛四联症根治术后的影响。收集患者特征、住院结局以及血流动力学参数、尿量、胸腔引流、液体平衡、实验室数据和血浆精氨酸加压素浓度的测量值，在基线和术后 48 小时进行测量。使用混合效应回归进行数据分析。
20 例患者被随机分配到加压素组和安慰剂组，每组 10 例。与安慰剂组相比，加压素组术后 48 小时的跨肺梯度（6.4 ± 0.5 比 8.3 ± 0.5mmHg，P=0.011）和胸腔引流（23 ± 20 比 40 ± 20mL/kg，P=0.028）均显著降低。术后 4 小时内，加压素组和安慰剂组的血浆精氨酸加压素浓度均高于基线，且加压素组在术后输注期间更高。两组间钠浓度、肝功能或肾功能无差异。
法洛四联症根治术后加压素输注似乎是安全的，可减少术后早期的跨肺梯度和胸腔引流。更大规模的多中心研究可能会显示出进一步的临床获益。
