Department of Pediatrics, Chicago Medical School, Chicago, IL, USA.
Division of Cardiology, Advocate Children's Hospital, Chicago, IL, USA.
Pediatr Cardiol. 2021 Dec;42(8):1792-1798. doi: 10.1007/s00246-021-02667-1. Epub 2021 Jun 28.
The use of vasopressin has been increased in recent years in children after congenital heart surgery. However, there is limited information regarding its effects on cardiac output, systemic oxygen delivery, and myocardial energetics. The purpose of this study is to characterize the effects of vasopressin infusions on hemodynamics and systemic oxygen delivery in children with congenital heart disease. A retrospective, single-center study of patients with congenital heart disease who received vasopressin infusions in a pediatric cardiac intensive care unit between January 2019 and May 2020. The measured values collected for study were systolic and diastolic blood pressure, heart rate, arterial oxygen saturation as determined by pulse oximetry, arterial pH, arterial partial pressure of oxygen, arterial partial pressure of carbon dioxide, serum lactate, serum sodium, and renal and cerebral oximetry based on near-infrared spectroscopy. The calculated values for this study were the difference between arterial and NIRS oximetry, the reno-cerebral near-infrared spectroscopy gradient and the vasoinotrope score. A Wilcoxon signed-rank test was utilized to compare values of paired continuous variables before and after initiation of the vasopressin infusion. Correlations were assessed using Spearman correlation analyses and stepwise regressions were completed. A total of 26 vasopressin infusions among 20 unique patients were included in the final analyses. Of these 26 vasopressin infusions, 18 were in patients with biventricular circulation and 8 were in patients with functionally univentricular circulation. The median vasopressin infusion dose at initiation was 0.4 (0.1-1) milliunits/kg/min. For the entire cohort 2 h after the initiation of vasopressin, systolic blood pressure increased to 8.4 mmHg, p < 0.01, but no significant correlation was found to markers of systemic oxygen delivery. Similar results were obtained when only those with biventricular circulation were considered. Those with functionally univentricular circulation were not found to have any statistically significant rise in blood pressure. Vasopressin infusions appear to statistically significantly increase systolic blood pressure in children with congenital heart disease who have a biventricular but not functionally univentricular circulation. Even when an increase in systolic blood pressure is present, systemic oxygen delivery did not improve.
近年来，在先天性心脏病手术后的儿童中，加压素的使用有所增加。然而，关于其对心输出量、全身氧输送和心肌能量学的影响的信息有限。本研究的目的是描述加压素输注对先天性心脏病儿童血流动力学和全身氧输送的影响。这是一项回顾性的单中心研究，纳入了 2019 年 1 月至 2020 年 5 月期间在儿科心脏重症监护病房接受加压素输注的先天性心脏病患者。本研究收集的测量值包括收缩压和舒张压、心率、脉搏血氧饱和度测定的动脉血氧饱和度、动脉 pH 值、动脉氧分压、动脉二氧化碳分压、血清乳酸、血清钠以及基于近红外光谱的肾和脑氧饱和度。本研究计算的值为动脉与 NIRS 血氧饱和度之间的差值、肾脑近红外光谱梯度和血管活性评分。使用 Wilcoxon 符号秩检验比较加压素输注前后配对连续变量的值。使用 Spearman 相关分析评估相关性，并完成逐步回归。最终分析纳入了 20 名患者中的 26 次加压素输注。在这 26 次加压素输注中，18 次用于双心室循环患者，8 次用于功能性单心室循环患者。起始时加压素输注剂量中位数为 0.4(0.1-1)毫单位/千克/分钟。对于整个队列，加压素起始后 2 小时收缩压升高至 8.4mmHg，p<0.01，但与全身氧输送标志物无显著相关性。仅考虑双心室循环患者时也得到了类似的结果。功能性单心室循环患者的血压无统计学显著升高。加压素输注似乎可使具有双心室但不具有功能性单心室循环的先天性心脏病儿童的收缩压统计学显著升高。即使收缩压升高，全身氧输送也没有改善。
