Jozwiak Mathieu, Geri Guillaume, Laghlam Driss, Boussion Kevin, Dolladille Charles, Nguyen Lee S
Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire l'Archet 1, Nice, France.
Equipe 2 CARRES UR2CA-Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur UCA, Nice, France.
Front Med (Lausanne). 2022 May 23;9:826446. doi: 10.3389/fmed.2022.826446. eCollection 2022.
Vasodilatory shock, such as septic shock, requires personalized management which include adequate fluid therapy and vasopressor treatments. While these potent drugs are numerous, they all aim to counterbalance the vasodilatory effects of a systemic inflammatory response syndrome. Their specific receptors include α- and β-adrenergic receptors, arginine-vasopressin receptors, angiotensin II receptors and dopamine receptors. Consequently, these may be associated with severe adverse effects, including acute mesenteric ischemia (AMI). As the risk of AMI depends on drug class, we aimed to review the evidence of plausible associations by performing a worldwide pharmacovigilance analysis based on the World Health Organization database, VigiBase®. Among 24 million reports, 104 AMI events were reported, and disproportionality analyses yielded significant association with all vasopressors, to the exception of selepressin. Furthermore, in a comprehensive literature review, we detailed mechanistic phenomena which may enhance vasopressor selection, in the course of treating vasodilatory shock.
血管舒张性休克，如脓毒性休克，需要个性化管理，包括充分的液体治疗和血管升压药治疗。虽然这类强效药物种类繁多，但它们的目的都是为了对抗全身炎症反应综合征的血管舒张作用。它们的特异性受体包括α和β肾上腺素能受体、精氨酸加压素受体、血管紧张素II受体和多巴胺受体。因此，这些药物可能会伴有严重的不良反应，包括急性肠系膜缺血（AMI）。由于AMI的风险取决于药物类别，我们旨在通过基于世界卫生组织数据库VigiBase®进行全球药物警戒分析，来综述可能存在关联的证据。在2400万份报告中，有104例AMI事件被报告，不成比例分析显示除了加压素外，所有血管升压药都存在显著关联。此外，在一项全面的文献综述中，我们详细阐述了在治疗血管舒张性休克过程中可能有助于血管升压药选择的机制现象。
