Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.
J Med Toxicol. 2022 Apr;18(2):145-154. doi: 10.1007/s13181-022-00885-4. Epub 2022 Mar 8.
Shock in drug poisoning is a life-threatening condition and current management involves fluid resuscitation and vasopressor therapy. Management is limited by the toxicity of high-dose vasopressors such as catecholamines. Clinical trials have shown the efficacy of angiotensin II as an adjunct vasopressor in septic shock. The aim of this review is to assess the use of angiotensin II in patients with shock secondary to drug overdose.
Medline (from 1946), Embase (from 1947) and PubMed (from 1946) databases were searched until July 2021 via OVID. Included studies were those with shock due to drug poisoning and received angiotensin II as part of their treatment regimen. Of the 481 articles identified, 13 studies (case reports and scientific abstracts) were included in the final analysis with a total of 14 patients. Extracted data included demographics, overdose drug and dosage, angiotensin II dosage, time of angiotensin II administration, haemodynamic changes, length of hospital stay, mortality, complications, cardiac function and other treatment agents used.
Thirteen studies were included consisting of 6 case reports, 6 scientific abstracts and 1 case series. Overdose drugs included antihypertensives (n = 8), psychotropics (n = 4), isopropanol (n = 1) and tamsulosin (n = 1). Out of a total of 14 patients, 3 patients died. Ten patients had their haemodynamic changes reported. In terms of MAP or SBP changes, three patients (30%) had an immediate response to angiotensin II, four patients (40%) had responses within 30 min, one patient (10%) within two hours and two patients (20%) did not have their time reported. Two patients were shown to have direct chronotropic effects within 30 min of angiotensin II administration. The median hospital stay for patients was 5 days (IQR = 4). The time from overdose until angiotensin II administration ranged from 5 to 56 h. Other vasopressors used included phenylephrine, noradrenaline, adrenaline, vasopressin, dobutamine, dopamine, methylene blue and ephedrine. A median of 3 vasopressors were used before initiation of angiotensin II. Twelve patients received angiotensin II as their final treatment.
Angiotensin II may be useful as an adjunct vasopressor in treating shock secondary to drug poisoning. However, the current literature consisted of only very low-quality studies. To truly assess the utility of angiotensin II use in drug-induced poisoned patients, further well-designed prospective studies are required.
药物中毒性休克是一种危及生命的病症，目前的治疗方法包括液体复苏和血管加压剂治疗。由于儿茶酚胺等大剂量血管加压剂的毒性，治疗受到限制。临床试验已经证明血管紧张素 II 作为败血症性休克辅助血管加压剂的疗效。本综述的目的是评估血管紧张素 II 在药物过量引起的休克患者中的应用。
通过 OVID 在 Medline（自 1946 年）、Embase（自 1947 年）和 PubMed（自 1946 年）数据库中进行搜索，检索截止日期为 2021 年 7 月。纳入的研究为因药物中毒引起休克并接受血管紧张素 II 作为其治疗方案一部分的研究。在确定的 481 篇文章中，最终分析纳入了 13 项研究（病例报告和科学摘要），共纳入 14 名患者。提取的数据包括人口统计学数据、药物过量和剂量、血管紧张素 II 剂量、血管紧张素 II 给药时间、血流动力学变化、住院时间、死亡率、并发症、心功能和其他使用的治疗药物。
共纳入 13 项研究，包括 6 项病例报告、6 项科学摘要和 1 项病例系列研究。药物过量药物包括降压药（n=8）、精神药物（n=4）、异丙醇（n=1）和坦索罗辛（n=1）。在总共 14 名患者中，有 3 名患者死亡。10 名患者的血流动力学变化得到了报道。在 MAP 或 SBP 变化方面，有 3 名患者（30%）对血管紧张素 II 立即有反应，4 名患者（40%）在 30 分钟内有反应，1 名患者（10%）在 2 小时内有反应，2 名患者（20%）未报告其时间。有 2 名患者在给予血管紧张素 II 后 30 分钟内显示出直接变时作用。患者的中位住院时间为 5 天（IQR=4）。血管紧张素 II 给药与药物过量之间的时间范围为 5 至 56 小时。其他使用的血管加压剂包括苯肾上腺素、去甲肾上腺素、肾上腺素、血管加压素、多巴酚丁胺、多巴胺、亚甲蓝和麻黄碱。在开始使用血管紧张素 II 之前，中位数使用了 3 种血管加压剂。12 名患者接受血管紧张素 II 作为最终治疗。
血管紧张素 II 可用作治疗药物中毒性休克的辅助血管加压剂。然而，目前的文献仅由非常低质量的研究组成。要真正评估血管紧张素 II 在药物引起的中毒患者中的使用效果，需要进一步进行精心设计的前瞻性研究。
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