Methodist DeBakey Heart & Vascular Center, Houston Methodist, Houston, Texas, US.
SUNY Upstate Medical University, Syracuse, New York, US.
Methodist Debakey Cardiovasc J. 2023 Aug 1;19(4):38-47. doi: 10.14797/mdcvj.1245. eCollection 2023.
Vasoplegia is a condition characterized by persistent low systemic vascular resistance despite a normal or high cardiac index, resulting in profound and uncontrolled vasodilation. Vasoplegia may occur due to various conditions, including cardiac failure, sepsis, and post-cardiac surgery. In the cardiac cohort, multiple risk factors for vasoplegia have been identified. Several factors contribute to the pathophysiology of this condition, and various mechanisms have been proposed, including nitric oxide, adenosine, prostanoids, endothelins, the renin-angiotensin-aldosterone system, and hydrogen sulfide. Early identification and prompt management of vasoplegia is crucial to prevent development of shock. This review expands upon the different vasopressors used in management of vasoplegia, including catecholamines such as norepinephrine, dopamine, epinephrine, phenylephrine, and other agents including vasopressin, methylene blue, angiotensin II, hydroxocobalamin, vitamin C, thiamine, and corticosteroids (ie, hydrocortisone). It also emphasizes the importance of conducting further research and making advancements in treatment regimens for vasoplegia.
血管麻痹是一种以持续低全身血管阻力为特征的病症,尽管心脏指数正常或升高,但导致广泛和不受控制的血管扩张。血管麻痹可能由于多种情况引起,包括心力衰竭、败血症和心脏手术后。在心脏队列中,已经确定了血管麻痹的多个危险因素。多种因素促成了这种情况的病理生理学,并且已经提出了多种机制,包括一氧化氮、腺苷、前列腺素、内皮素、肾素-血管紧张素-醛固酮系统和硫化氢。早期识别和及时治疗血管麻痹对于预防休克的发生至关重要。这篇综述详细介绍了用于治疗血管麻痹的不同血管加压药,包括儿茶酚胺如去甲肾上腺素、多巴胺、肾上腺素、苯肾上腺素等,以及其他药物如血管加压素、亚甲蓝、血管紧张素 II、羟钴胺素、维生素 C、硫胺素和皮质类固醇(如氢化可的松)。它还强调了进行进一步研究和在血管麻痹治疗方案方面取得进展的重要性。