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Vasopressin in shock states

机译：加压素处于休克状态

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There is growing evidence that in end-stage shock or during cardiac arrest, inappropriately low endogenous vasopressin plasma levels may be responsible for pathologic vasodilatation, inadequate organ perfusion, and poor outcome. The purpose of this article is to review recent publications featuring arginine vasopressin as a potent vasoconstrictor in various shock states such as systemic vasodilatation, severe hypovolemia, or cardiac arrest.Several retrospective investigations give evidence that vasopressin at a dosage of 2-6 U/h is effective in reversing catecholamine-resistant vasodilatory shock due to sepsis or after cardiopulmonary bypass, but prospective randomized controlled trials are warranted. In experimental hypovolemic cardiac arrest or therapy-resistant (irreversible) hypovolemic shock, vasopressin may be an intriguing therapy, although human evidence is not available. Animal data gives strong evidence that vasopressin given during cardiopulmonary resuscitation improves both return of spontaneous circulation and neurological outcome. Clinical experience on the use of vasopressin for in-hospital cardiopulmonary resuscitation with short response time showed equipotency with epinephrine; in patients with out-of-hospital ventricular fibrillation, vasopressin showed improved 24 h survival in comparison with epinephrine. After the large European multicenter study completed in summer 2002, we will hopefully be able to better determine the role of vasopressin versus epinephrine in the management of adult cardiac arrest.Vasopressin administration is emerging as a rational and promising therapy in the management of various shock states and cardiac arrest.
机译：越来越多的证据表明，在末期休克或心脏骤停期间，内源性加压素血浆水平过低可能是病理性血管扩张，器官灌注不足和不良预后的原因。本文的目的是回顾以精氨酸加压素为有效的血管收缩剂在各种休克状态（例如全身性血管舒张，严重血容量不足或心脏骤停）中的最新出版物。多次回顾性研究提供了证据表明，加压素的使用量为2-6 U / h可有效逆转败血症或体外循环后因儿茶酚胺引起的血管舒张性休克，但仍需进行前瞻性随机对照试验。在实验性低血容量性心脏骤停或抗药性（不可逆）低血容量性休克中，加压素可能是一种有趣的疗法，尽管尚无人类证据。动物数据提供了有力的证据，表明心肺复苏过程中给予的加压素可改善自然循环的恢复和神经系统的预后。使用血管加压素进行医院内心肺复苏且反应时间短的临床经验表明，肾上腺素具有同等效力。与肾上腺素相比，在院外心室纤颤患者中，加压素显示24小时生存率提高。在2002年夏季完成了一项大型的欧洲多中心研究后，我们有望能够更好地确定血管加压素与肾上腺素在成人心脏骤停管理中的作用。血管加压素正在成为治疗各种休克状态的一种合理且有希望的疗法和心脏骤停。

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