Robinson John C, ElSaban Mariam, Smischney Nathan J, Wieruszewski Patrick M
Department of Pharmacy, Mayo Clinic, Phoenix, AZ 85054, United States.
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, United States.
World J Clin Cases. 2024 Dec 26;12(36):6892-6904. doi: 10.12998/wjcc.v12.i36.6892.
Intravenous (IV) vasopressors are essential in the management of hypotension and shock. Initiation of oral vasoactive agents to facilitate weaning of IV vasopressors to liberate patients from the intensive care unit is common despite conflicting evidence regarding the benefits of this practice. While midodrine appears to be the most frequently studied oral vasoactive agent for this purpose, its adverse effect profile may preclude its use in certain populations. In addition, some patients may require persistent use of IV vasopressors for hypotension refractory to midodrine. The use of additional and alternative oral vasoactive agents bearing different mechanisms of action is emerging. This article provides a comprehensive review of the pharmacology, clinical uses, dosing strategies, and safety considerations of oral vasoactive agents and their application in the intensive care setting.
静脉血管加压药在低血压和休克的治疗中至关重要。尽管关于这种做法的益处存在相互矛盾的证据，但启动口服血管活性药物以促进静脉血管加压药的撤药从而使患者脱离重症监护病房的情况很常见。虽然米多君似乎是为此目的研究最多的口服血管活性药物，但其不良反应可能使其无法在某些人群中使用。此外，一些患者可能需要持续使用静脉血管加压药来治疗对米多君难治的低血压。具有不同作用机制的其他口服血管活性药物的使用正在兴起。本文全面综述了口服血管活性药物的药理学、临床用途、给药策略和安全性考虑因素及其在重症监护环境中的应用。
