Morris D C, Dereczyk B E, Grzybowski M, Martin G B, Rivers E P, Wortsman J, Amico J A
Henry Ford Health Systems, Detroit, MI, Department of Emergency Medicine 48202-3540, USA.
Acad Emerg Med. 1997 Sep;4(9):878-83. doi: 10.1111/j.1553-2712.1997.tb03813.x.
To determine the hemodynamic effect of vasopressin on coronary perfusion pressure (CPP) in prolonged human cardiac arrest.
A prospective, open-label clinical trial of vasopressin during cardiac resuscitation was performed. Ten patients presenting in cardiac arrest initially received resuscitative measures by emergency physicians according to Advanced Cardiac Life Support (ACLS) guidelines. A central venous catheter for fluid and drug administration and a femoral artery catheter for measurement of CPP (aortic minus right atrial relaxation phase pressures) were placed. When each patient was deemed nonsalvageable, 1.0 mg epinephrine was given and CPP was measured for 5 minutes, followed by a dose of vasopressin (1.0 U/kg). CPP measurements were continued for another 5 minutes.
The mean duration of cardiac arrest (out-of-hospital interval plus duration of ED ACLS) was 39.6 +/- 16.5 min. There was no improvement in CPP after 1.0 mg of epinephrine. Vasopressin administration resulted in a significant increase of CPP in 4 of the 10 patients. Patients responding to vasopressin had a mean increase in CPP of 28.2 +/- 16.4 mm Hg (range: 10-51.5), with these peak increases occurring at 15 seconds to 4 minutes after administration. The increases in the vasopressin levels after administration did not differ between the responders and nonresponders.
In this human model of prolonged cardiac arrest, 40% of the patients receiving vasopressin had a significant increase in CPP. This pilot study suggests that investigation of earlier use of vasopressin as a therapeutic alternative in the treatment of cardiac arrest is warranted.
确定血管加压素对长时间心脏骤停患者冠状动脉灌注压（CPP）的血流动力学影响。
进行了一项关于心脏复苏期间血管加压素的前瞻性、开放标签临床试验。10例心脏骤停患者最初由急诊医生根据高级心脏生命支持（ACLS）指南进行复苏措施。放置用于输液和给药的中心静脉导管以及用于测量CPP（主动脉减去右心房舒张期压力）的股动脉导管。当每位患者被判定无法挽救时，给予1.0mg肾上腺素并测量CPP 5分钟，随后给予一剂血管加压素（1.0U/kg）。继续测量CPP另外5分钟。
心脏骤停的平均持续时间（院外间隔时间加急诊ACLS持续时间）为39.6±16.5分钟。给予1.0mg肾上腺素后CPP无改善。给予血管加压素后，10例患者中有4例CPP显著升高。对血管加压素产生反应的患者CPP平均升高28.2±16.4mmHg（范围：10 - 51.5），这些峰值升高发生在给药后15秒至4分钟。给药后血管加压素水平的升高在反应者和无反应者之间无差异。
在这个长时间心脏骤停的人体模型中，40%接受血管加压素治疗的患者CPP显著升高。这项初步研究表明，有必要对更早使用血管加压素作为心脏骤停治疗的替代疗法进行研究。
