血動力学的に不安定な臓器提供者におけるバソプレシン欠乏症とプレッサー過敏症
J M Chen1, S Cullinane, T B Spanier
1Division of Cardiothoracic Surgery, Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY, USA. jmc23@columbia.edu
Circulation
|November 24, 1999
まとめ
ヴァソプレシン欠乏症は,低血圧の臓器提供者に一般的です. ヴァソプレシン置換療法により,これらの患者では血圧が効果的に上昇し,カテキオラミンの血管圧縮剤の必要性が軽減されます.
科学分野:
- ネフロロジーは腎臓科です.
- エンドクリノロジー エンドクリノロジー
- クリティカルケア・メディシン
背景:
- 固体臓器提供者は,血管拡張による低血圧を頻繁に経験します.
- 血管拡張状態は,しばしばバソプレシン欠乏症と過敏症に関連しています.
- この研究では,糖尿病のない低血圧の臓器提供者におけるバソプレシン欠乏症を調査した.
研究 の 目的:
- 低血圧の臓器提供者におけるバソプレシン欠乏症の有病率を決定する.
- これらのドナーにおけるバソプレシン置換の血管圧縮効果を評価する.
主な方法:
- 50人の血液動力学的に不安定な臓器提供者 (平均動脈圧 [MAP] ≤70mmHg カテコアミンにもかかわらず) を研究した.
- 低用量バソプレシン (0.040.1 U/min) を10人の適格な患者に投与した.
- 測定対象は,MAP,カテキオラミンの必要量,血清バソプレシン,およびバソプレシン輸注前および後の血清オスモラリティでした.
主要な成果:
- ヴァソプレシン投与は,MAPを72.2±3.5から89.8±4.2mm Hg (P<0.05) に増加させた.
- カテコラミンプレッサーは40%の患者で中止され,40%の患者で減少しました.
- 血バソプレシン濃度は低かった (2.9±0.8 pg/mL) 低血圧の程度に比べて.
結論:
- 明らかに糖尿病不発症のない血液動力学的に不安定な臓器提供者は,バロレフレクスの媒介によるバソプレシン分泌の障害を示します.
- 低用量のバソプレシンは,これらの患者の血圧を著しく改善します.
- ヴァソプレシン治療は,カテキオラミン血管圧縮剤の必要性を減少させます.
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