Bronicki Ronald A, Acosta Sebastian, Savorgnan Fabio, Flores Saul, Achuff Barbara-Jo, Loomba Rohit, Ahmed Mubbasheer, Ghanayem Nancy, Heinle Jeffrey S, Asadourian Vicken, Lasa Javier J
Division of Critical Care Medicine & Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Tex.
JTCVS Open. 2022 Jan 22;9:217-224. doi: 10.1016/j.xjon.2022.01.008. eCollection 2022 Mar.
Arginine vasopressin (AVP) is used to treat hypotension. Because AVP increases blood pressure by increasing systemic vascular resistance, it may have an adverse effect on tissue oxygenation following the Norwood procedure.
Retrospective analysis of continuously captured hemodynamic data of neonates receiving AVP following the Norwood procedure.
We studied 64 neonates exposed to AVP within 7 days after the Norwood procedure. For the entire group, AVP significantly increased mean blood pressure (2.5 ± 6.3) and cerebral and renal oxygen extraction ratios (4.1% ± 9.6% and 2.0% ± 4.7%, respectively; < .001 for all values). In the right ventricle to pulmonary artery shunt cohort, AVP significantly increased blood pressure, arterial oxygen saturation (1.4% ± 3.8%; = .011), pulmonary to systemic perfusion ratio (0.2 ± 0.4; = .017), and cerebral and renal oxygen extraction ratios (4.6% ± 8.7%; = .010% and 4.7% ± 9.4%; = .014, respectively). The Blalock-Taussig shunt cohort experienced a less significant vasopressor response and no change in arterial oxygen saturation, pulmonary to systemic perfusion ratio, or cerebral and renal oxygen extraction ratios.
The right ventricle to pulmonary artery shunt cohort experienced a significant vasopressor response to AVP that was associated with a significant increase in pulmonary perfusion and decrease in cerebral and renal perfusion, whereas the Blalock-Taussig shunt cohort experienced a less significant vasopressor response and no change in pulmonary or systemic perfusion. The influence of AVP on tissue oxygenation following the Norwood procedure may have clinical implications that require further study.
精氨酸加压素（AVP）用于治疗低血压。由于AVP通过增加全身血管阻力来升高血压，它可能在诺伍德手术（Norwood procedure）后对组织氧合产生不利影响。
对诺伍德手术后接受AVP治疗的新生儿连续采集的血流动力学数据进行回顾性分析。
我们研究了64例在诺伍德手术后7天内接受AVP治疗的新生儿。对于整个组，AVP显著升高平均血压（2.5±6.3）以及脑和肾的氧摄取率（分别为4.1%±9.6%和2.0%±4.7%；所有值P<0.001）。在右心室至肺动脉分流组中，AVP显著升高血压、动脉血氧饱和度（1.4%±3.8%；P=0.011）、肺循环与体循环灌注比（0.2±0.4；P=0.017）以及脑和肾的氧摄取率（分别为4.6%±8.7%；P=0.010和4.7%±9.4%；P=0.014）。布莱洛克-陶西格分流（Blalock-Taussig shunt）组的血管升压药反应不太显著，动脉血氧饱和度、肺循环与体循环灌注比以及脑和肾的氧摄取率均无变化。
右心室至肺动脉分流组对AVP有显著的血管升压药反应，这与肺灌注显著增加以及脑和肾灌注减少有关，而布莱洛克-陶西格分流组的血管升压药反应不太显著，肺或体循环灌注无变化。诺伍德手术后AVP对组织氧合的影响可能具有临床意义，需要进一步研究。
