Barnes Theresa J, Hockstein Maxwell A, Jabaley Craig S
Department of Anesthesiology, Emory University, Atlanta, GA, USA.
SAGE Open Med. 2020 Jun 25;8:2050312120935466. doi: 10.1177/2050312120935466. eCollection 2020.
Cardiovascular disease remains the leading cause of death in the United States, and cardiopulmonary bypass is a cornerstone in the surgical management of many related disease states. Pathophysiologic changes associated both with extracorporeal circulation and shock can beget a syndrome of low systemic vascular resistance paired with relatively preserved cardiac output, termed vasoplegia. While increased vasopressor requirements accompany vasoplegia, related pathophysiologic mechanisms may also lead to true catecholamine resistance, which is associated with further heightened mortality. The introduction of a second non-catecholamine vasopressor, angiotensin II, and non-specific nitric oxide scavengers offers potential means by which to manage this challenging phenomenon. This narrative review addresses both the definition, risk factors, and pathophysiology of vasoplegia and potential therapeutic interventions.
心血管疾病仍然是美国的主要死因，而体外循环是许多相关疾病外科治疗的基石。与体外循环和休克相关的病理生理变化可引发一种综合征，即体循环血管阻力降低而心输出量相对保留，称为血管麻痹。虽然血管麻痹时血管升压药需求增加，但相关的病理生理机制也可能导致真正的儿茶酚胺抵抗，这与死亡率进一步升高有关。引入第二种非儿茶酚胺血管升压药血管紧张素II和非特异性一氧化氮清除剂提供了应对这一具有挑战性现象的潜在手段。本叙述性综述探讨了血管麻痹的定义、危险因素、病理生理学以及潜在的治疗干预措施。
