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精氨酸加压素对脊髓损伤所致自主神经反射异常患者难治性失血性休克的治疗效果。

Effectiveness of arginine vasopressin for the management of refractory hemorrhagic shock in a patient with autonomic dysreflexia caused by spinal cord injury.

作者信息

Shimauchi Tsukasa, Maki Jun, Yoshino Jun, Fujimura Naoyuki, Hoka Sumio

机构信息

Operating Rooms, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.

Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.

出版信息

JA Clin Rep. 2018 Nov 12;4(1):79. doi: 10.1186/s40981-018-0216-8.

DOI:10.1186/s40981-018-0216-8
PMID:32026013
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6966762/
Abstract

BACKGROUND

Arginine vasopressin has been used for the management of refractory vasodilatory shock. However, it is still unclear whether arginine vasopressin is useful for hypotension in patients with spinal cord injury.

CASE DESCRIPTION

A 78-year-old man with autonomic dysreflexia and paralysis below the level corresponding to Th2 due to spinal cord injury previously underwent cholecystectomy. During the surgery, accidental hemorrhage led him to refractory hemorrhagic shock unresponsive to fluid resuscitation and catecholamine. Lasting hypotension was improved with arginine vasopressin.

CONCLUSION

We described a rare case report on the use of arginine vasopressin for management of refractory hemorrhagic shock in a patient with autonomic dysreflexia.

摘要

背景

精氨酸加压素已被用于治疗难治性血管舒张性休克。然而,精氨酸加压素对脊髓损伤患者的低血压是否有用仍不清楚。

病例描述

一名78岁男性,因脊髓损伤导致自主神经反射异常,且在相当于胸2水平以下瘫痪,此前接受过胆囊切除术。手术期间,意外出血导致他出现难治性失血性休克,对液体复苏和儿茶酚胺无反应。精氨酸加压素使持续的低血压得到改善。

结论

我们描述了一例罕见病例,即使用精氨酸加压素治疗一名患有自主神经反射异常患者的难治性失血性休克。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b30/6966762/6eaaddf14c36/40981_2018_216_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b30/6966762/6eaaddf14c36/40981_2018_216_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8b30/6966762/6eaaddf14c36/40981_2018_216_Fig1_HTML.jpg

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Cardiovascular Physiology and Responses to Sexual Activity in Individuals Living with Spinal Cord Injury.脊髓损伤患者的心血管生理学及对性活动的反应
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Autonomic dysreflexia: a cardiovascular disorder following spinal cord injury.自主神经反射异常:脊髓损伤后的一种心血管疾病。
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Arginine vasopressin, copeptin, and the development of relative AVP deficiency in hemorrhagic shock.
精氨酸加压素、 copeptin 与失血性休克中相对性抗利尿激素缺乏的发生发展
Am J Surg. 2017 Oct;214(4):589-595. doi: 10.1016/j.amjsurg.2017.06.015. Epub 2017 Jun 24.
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Vasopressors: Do they have any role in hemorrhagic shock?血管升压药:它们在失血性休克中起作用吗?
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Spinal cord injury enhances arterial expression and reactivity of α1-adrenergic receptors-mechanistic investigation into autonomic dysreflexia.脊髓损伤增强α1-肾上腺素能受体的动脉表达和反应性——自主神经反射异常的机制研究
Spine J. 2016 Jan 1;16(1):65-71. doi: 10.1016/j.spinee.2015.09.030. Epub 2015 Oct 1.
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Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm.观察 IMPROVE 试验中关于破裂性腹主动脉瘤患者的临床护理情况。
Br J Surg. 2014 Feb;101(3):216-24; discussion 224. doi: 10.1002/bjs.9410.
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