Semedi Bambang Pujo, Rehatta Nancy Margarita, Soetjipto Soetjipto, Nugraha Jusak, Mahyuddin Muhammad H, Arnindita Jannatin N, Wairooy Nabilah A P
Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60132, Indonesia.
Department of Anesthesiology and Reanimation, Medical Faculty of Medicine, Universitas Airlangga-Dr Soetomo General Hospital, Surabaya, East Java, 60132, Indonesia.
Open Access Emerg Med. 2023 Jan 5;15:1-11. doi: 10.2147/OAEM.S391167. eCollection 2023.
Patients with severe vasodilation accompanied by refractory hypotension despite high doses of vasopressors were associated with a high mortality rate. The Ang-2 for the Treatment of High-Output Shock (ATHOS) 3 trial demonstrated that angiotensin 2 (Ang-2) could effectively increase MAP and blood pressure in vasodilatory shock patients. This systematic review aims to summarize the impact of Ang-2 for the treatment of vasodilatory shock on clinical outcomes, including length of stay, MAP level (before and after), and mortality also Ang-2 dose needed.
A systematic search in PubMed, Sage, ScienceDirect, Scopus and Gray literature was conducted to obtain studies about the use of Ang-2 in vasodilatory shock patients.
In all of the studies that we obtained, there were different results regarding mortality in patients with vasodilatory shock with Ang-2. Mortality was significantly lower when Ang-2 was administered to patients with elevated renin. The initial dose of Ang-2 can be started at 10-20 ng/kg/min, but there is no agreement on the maximum dose. Ang-2 may be considered a third-line vasopressor if the targeted MAP has not been achieved after administration of norepinephrine >200 ng/kg/min for more than 6 hours. Although not statistically significant, the use of Ang-2 can reduce the length of stay in the ICU and in the hospital when compared to patients without Ang-2 therapy, in addition to reducing the dose of vasopressor.
Overall, the use of Ang-2 has potential to be a regimen for patients with vasodilatory shock. Further study is needed to obtain more data.
尽管使用了高剂量血管升压药，但伴有严重血管扩张和难治性低血压的患者死亡率很高。血管紧张素2治疗高输出量休克（ATHOS）3试验表明，血管紧张素2（Ang-2）可有效提高血管舒张性休克患者的平均动脉压（MAP）和血压。本系统评价旨在总结Ang-2治疗血管舒张性休克对临床结局的影响，包括住院时间、MAP水平（治疗前后）、死亡率以及所需的Ang-2剂量。
在PubMed、Sage、ScienceDirect、Scopus和灰色文献中进行系统检索，以获取关于Ang-2在血管舒张性休克患者中应用的研究。
在我们检索到的所有研究中，关于Ang-2治疗血管舒张性休克患者死亡率的结果各不相同。给肾素升高的患者使用Ang-2时，死亡率显著降低。Ang-2的初始剂量可从10-20 ng/kg/min开始，但关于最大剂量尚无共识。如果在给予去甲肾上腺素>200 ng/kg/min超过6小时后仍未达到目标MAP，则可将Ang-2视为三线血管升压药。与未接受Ang-2治疗的患者相比，使用Ang-2除了可减少血管升压药的剂量外，虽无统计学意义，但可缩短重症监护病房（ICU）住院时间和住院时间。
总体而言，Ang-2的使用有可能成为血管舒张性休克患者的一种治疗方案。需要进一步研究以获得更多数据。
