Department of Pharmacy, University of New Mexico Hospital, Albuquerque, NM, USA.
Department of Critical Care and Emergency Medicine, University of New Mexico Hospital, Albuquerque, NM, USA.
Am J Health Syst Pharm. 2022 Sep 7;79(18):1521-1530. doi: 10.1093/ajhp/zxac164.
The pathophysiology and hemodynamic management of acute spinal cord injuries, including the use of intravenous and enteral vasoactive agents, are reviewed.
Spinal cord injuries are devastating neurological insults that in the acute setting lead to significant hemodynamic disturbances, including hypotension and bradycardia, that are influenced by the level of injury. High thoracic (usually defined as at or above T6) and cervical injuries often manifest with hypotension and bradycardia due to destruction of sympathetic nervous system activity and unopposed vagal stimulation to the myocardium, whereas lower thoracic injuries tend to result in hypotension alone due to venous pooling. Initial management includes maintaining euvolemia with crystalloids and maintaining or augmenting mean arterial pressure with the use of intravenous vasoactive agents to improve neurological outcomes. Choice of vasopressor should be based on patient-specific factors, particularly level of injury and presenting hemodynamics. This review includes the most recent literature on intravenous vasopressors as well as the limited evidence supporting the use of enteral vasoactive agents. Enteral vasoactive agents may be considered, when clinically appropriate, as a strategy to wean patients off of intravenous agents and facilitate transfer outside of the intensive care unit.
The hemodynamic management of acute spinal cord injuries often requires the use of vasoactive agents to meet mean arterial pressure goals and improve neurological outcomes. Patient-specific factors must be considered when choosing intravenous and enteral vasoactive agents.
回顾急性脊髓损伤的病理生理学和血液动力学管理，包括静脉和肠内血管活性药物的使用。
脊髓损伤是一种破坏性的神经损伤，在急性期会导致显著的血液动力学紊乱，包括低血压和心动过缓，这些紊乱受损伤水平的影响。高位（通常定义为 T6 或以上）和颈段损伤常因交感神经系统活动破坏和心肌迷走神经刺激而导致低血压和心动过缓，而低位胸段损伤则因静脉充血而单独导致低血压。初始治疗包括用晶体液维持血容量，并用静脉血管活性药物维持或增加平均动脉压，以改善神经功能预后。血管加压药的选择应基于患者的具体情况，特别是损伤水平和现有血液动力学。这篇综述包括了关于静脉血管加压药的最新文献，以及支持使用肠内血管活性药物的有限证据。在临床适当的情况下，可以考虑使用肠内血管活性药物，作为使患者脱离静脉药物并促进转移到重症监护病房之外的策略。
急性脊髓损伤的血液动力学管理通常需要使用血管活性药物来达到平均动脉压目标并改善神经功能预后。在选择静脉和肠内血管活性药物时，必须考虑患者的具体情况。
