小剂量精氨酸加压素在血管扩张性休克病人中的应用

Effects of low-dose arginine vasopressin in vasodilatory shock

目的观察小剂量精氨酸加压素(arginine vasopressin,AVP)在血管扩张性休克病人治疗中的作用及其并发症。方法对17例血管扩张性休克病人进行了研究。病人均予儿茶酚胺类药物治疗,在充分容量治疗后加用小剂量AVP(<0.04U/min),在维持MAP≥65mmHg的基础上逐步调整儿茶酚胺类药物的剂量。记录AVP治疗前后的血流动力学参数、肾功能、儿茶酚胺类药物的用量、并发症及病人的预后。结果予小剂量AVP治疗后,病人HR和儿茶酚胺类药物的剂量均显著下降(P<0.01),MAP显著升高(P<0.05),心脏指数(CI)显著下降(P<0.01),每搏量指数(SVI)和周身血管阻力指数(SVRI)均显著升高(P<0.05),尿量显著增加(P<0.01),血肌酐(Cr)显著下降(P<0.01),肌酐清除率(CL)显著升高(P<0.01)。结论加用小剂量AVP治疗可明显改善血管扩张性休克病人的血流动力学,可减少儿茶酚胺类药物的需要量,并改善肾功能。

Objective To assess the effects of a small dose of arginine vasopressin （AVP） on hemodynamic, clinical, and laboratory variables in vasodilatory shock. Methods Seventeen patients with vasodilatory shock were studied. All patients received catecholamine therapy. After adequate fluid resuscitation, AVP was infused at a starting rate of 0. 008 U/min, and the max rate was less than 0.04 U/min. Catecholamine dosage was adjusted to maintain a mean arterial pressure ≥ 65 mmHg. Hemodynamic, urine output, creatinine and catecholamine dosage were recorded before the study and at 8 hours after administration of AVP. AVP dosage, clinic adverse side effects and intensive care unit mortality were documented as well. Results A small dose of AVP increased, mean arterial pressure, stroke volume index, systemic vascular resistance index, urine output and creatinine clearance. Heart rate, cardiac index and catecholamine requirements decreased. Central venous pressure and intrathoracic blood volume index was no difference. The intensive care unit mortality was 23.53%. Conclusion Supplementary a small dose of AVP infusion improves cardiocirculatory function and renal function in vasodilatory shock, and decreases catecholamine requirements and intensive care unit mortality.