一项关于休克中血管紧张素 II 的多中心观察性队列研究。
A Multicenter Observational Cohort Study of Angiotensin II in Shock.
机构信息
15506University of Georgia College of Pharmacy, Augusta, Georgia, GA, USA.
21693University of Mississippi School of Medicine, Jackson, MS, USA.
出版信息
J Intensive Care Med. 2022 Jan;37(1):75-82. doi: 10.1177/0885066620972943. Epub 2020 Nov 24.
INTRODUCTION
Angiotensin II (Ang-2) is a non-catecholamine vasopressor that targets the renin-angiotensin-aldosterone system by agonism of the angiotensin type 1 receptor. Its utility as a vasopressor and a catecholamine-sparing agent was demonstrated in the pivotal ATHOS-3 trial, and numerous post-hoc analyses have shown reduced mortality in certain subsets of the population.
METHODS
Consecutive adult patients at 5 centers who received Ang-2 from 2017-2020 were included in this multicenter, retrospective observational cohort study. Patient demographics, hemodynamics, and adverse events were collected. The primary outcomes of the study were the mean difference in MAP and norepinephrine (NEpi)-equivalent dose at hours 0 and 3 following initiation of Ang-2 therapy.
RESULTS
One hundred and sixty-two patients were included in this study. The primary outcomes of an increase in MAP (mean difference 9.3 mmHg, 95% CI 6.4-12.1, p < 0.001) and a reduction in NEpi equivalent dose (mean difference 0.16 µg/kg/min, 95% CI 0.10-0.22, p < 0.001) between hours 0 and 3 were statistically significant. The median time to reach a MAP ≥65 was 16 minutes (IQR 5-60 min). After stratifying patients by the NED dose and number of vasopressors administered prior to the initiation of Ang-2, those with a NED dose < 0.2 µg/kg/min, NED dose < 0.3 µg/kg/min, or those on ≤ 3 vasopressors had a significantly greater reduction in NED by hour 3 than those patients above these thresholds.
CONCLUSION
Ang-2 is an effective vasopressor and reduces catecholamine dose significantly. Its effect is rapid, with target MAP obtained within 30 minutes in most patients. Given the critical importance of adequate blood pressure to organ perfusion, Ang-2 should be considered when target MAP cannot be achieved with conventional vasopressors. Ang-2 should be utilized early in the course of shock, before the NED dose exceeds 0.2-0.3 µg/kg/min and before the initiation of the fourth-line vasopressor.
简介
血管紧张素 II（Ang-2）是一种非儿茶酚胺血管加压素，通过血管紧张素 1 型受体激动作用靶向肾素-血管紧张素-醛固酮系统。在关键的 ATHOS-3 试验中，它作为血管加压素和儿茶酚胺节约剂的效用得到了证明，并且许多事后分析表明，某些人群亚组的死亡率降低。
方法
本多中心回顾性观察队列研究纳入了 2017 年至 2020 年期间在 5 个中心接受 Ang-2 治疗的连续成年患者。收集患者的人口统计学、血流动力学和不良事件数据。该研究的主要结局是在开始 Ang-2 治疗后 0 小时和 3 小时时 MAP 和去甲肾上腺素（NEpi）等效剂量的平均差异。
结果
本研究共纳入 162 例患者。MAP 升高（平均差异 9.3mmHg，95%CI 6.4-12.1，p<0.001）和 NEpi 等效剂量降低（平均差异 0.16µg/kg/min，95%CI 0.10-0.22，p<0.001）的主要结局在统计学上具有显著意义。达到 MAP≥65mmHg 的中位时间为 16 分钟（IQR 5-60 分钟）。根据开始使用 Ang-2 前的 NED 剂量和使用的血管加压剂数量对患者进行分层后，NED 剂量<0.2µg/kg/min、NED 剂量<0.3µg/kg/min 或使用≤3 种血管加压剂的患者在第 3 小时时 NEpi 剂量的降低明显大于这些阈值以上的患者。
结论
Ang-2 是一种有效的血管加压素，可显著减少儿茶酚胺剂量。其作用迅速，大多数患者在 30 分钟内达到目标 MAP。鉴于充足的血压对器官灌注至关重要，当常规血管加压剂无法达到目标 MAP 时，应考虑使用 Ang-2。Ang-2 应在休克发生早期，即在 NED 剂量超过 0.2-0.3µg/kg/min 之前，以及在开始使用第四线血管加压剂之前使用。
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