Baylor St. Lukes Medical Center, 6720 Bertner Avenue, Room 0-520, Houston, TX 77030, USA.
Department of Pharmacy, Mayo Clinic, RO_MB_GR_722PH, 200 First Street Southwest, Rochester, MN 55905, USA.
Crit Care Clin. 2024 Jan;40(1):73-88. doi: 10.1016/j.ccc.2023.06.002. Epub 2023 Sep 7.
Vasoplegic shock after cardiac surgery is characterized by hypotension, a high cardiac output, and vasodilation. Much of the understanding of this pathologic state is informed by the understanding of septic shock. Adverse outcomes and mortality are increased with vasoplegic shock. Early recognition and a systematic approach to its management are critical. The need for vasopressors to sustain an adequate blood pressure as well as pharmacologic adjuncts to mitigate the inflammatory inciting process are necessary. The rationale behind vasopressor escalation and consideration of adjuncts are discussed.
心脏手术后出现的血管麻痹性休克的特点是低血压、心输出量高和血管扩张。对这种病理状态的认识主要来自对感染性休克的认识。血管麻痹性休克会增加不良预后和死亡率。早期识别和系统的管理方法至关重要。需要使用血管加压药来维持足够的血压,以及使用药物辅助来减轻炎症触发过程。本文讨论了血管加压药升级的基本原理和辅助治疗的考虑因素。