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Use of pressors in the treatment of cardiac arrest

ANNALS OF EMERGENCY MEDICINE 2001年第4期37卷 S152-S162页

作者： Babbs, CF Berg, RA Kette, F Kloeck, WGJ Lindner, KH Lurie, KG Morley, PT Nadkarni, VM Otto, CW Paradis, NA Perlman, J Stiell, I Timerman, A Van Reempts, P Wenzel, V Thomas Jefferson Univ Sch Med AI duPont Hosp Children Wilmington DE 19899 USA Univ Innsbruck A-6020 Innsbruck Austria Thomas Jefferson Univ Sch Med Wilmington DE USA Purdue Univ W Lafayette IN 47907 USA Univ Arizona Tucson AZ USA S Maria della Misercordia Hosp Udine Italy Resusicitat Council So Africa Johannesburg South Africa Univ Minnesota Sch Med Minneapolis MN USA Royal Melbourne Hosp Melbourne Vic Australia Univ Colorado Hlth Sci Ctr Denver CO 80202 USA Univ Texas SW Med Sch Dallas TX 75230 USA Loeb Res Inst Ottawa ON Canada Univ Antwerp Hosp Antwerp Belgium Univ Innsbruck A-6020 Innsbruck Austria

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PERIPHERAL VASOPRESSIN FOR SAFE AND ADEQUATE CONTROL OF PORTAL-HYPERTENSION DURING SHUNT OPERATIONS

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AMERICAN JOURNAL OF SURGERY 1976年第1期131卷 103-107页

作者： SIRINEK, KR MARTIN, EW THOMFORD, NR OHIO STATE UNIV COLL MED DEPT SURG COLUMBUS OH USA

Nine patients with cirrhosis and portal hypertension were given intraoperative vasopressin (40 U/hr) in a continuous peripheral infusion during establishment of a distal splenorenal shunt. In all patients a significant and sustained reduction in portal venous pressure was achieved. As a result, blood loss during dissection and the time required for operation were minimized. The expected vasopressin-induced reduction in cardiac output was limited to a transient decrease at 5 minutes. There were no significant cardiac arrhythmias. These results suggest that vasopressin given through a peripheral vein during shunt operations is safe and facilitates dissection by providing significant and sustained reductions in portal venous pressure.

关键词：血压/药物作用药物评价高血压门静脉/外科学输注胃肠外肾静脉/外科学脾静脉/外科学血管升压素类/投药和剂量血管升压素类/治疗应用成年人老年人女(雌)性人类男(雄)性中年人

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SELECTIVE INTRA-ARTERIAL INFUSION OF VASOPRESSIN FOR CONTROL OF GASTROINTESTINAL BLEEDING - EXPERIENCE WITH 35 CASES

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GASTROINTESTINAL RADIOLOGY 1976年第1期1卷 59-65页

作者： MELSON, GL GEISSE, G STANLEY, RJ WASHINGTON UNIV SCH MEDMALLINCKRODT INST RADIOLST LOUISMO 63110

Selective intraarterial infusion of vasopressin was performed in 32 patients for 35 episodes of gastrointestinal bleeding. Active bleeding was from esophageal varices in 11 cases and from an arterial site in 22 (stomach 11, duodenum 1, jejunum 2, colon 7, liver 1), including a jejunal diverticulum and a colonic ulcer in Behcet's disease. Two patients, not actively bleeding, were infused for portal decompression before an elective mesocaval shunt. Active bleeding was controlled in 64% of patients with variceal hemorrhage and in 59% of those with arterial sources. Infusion periods ranged from 15 minutes to 70 hours. There were no significant complications directly attributable to this therapy.

关键词：血管造影术胃肠出血/药物疗法胃肠出血/病因学胃肠出血/放射摄影术输注动脉内肠/血液供给胃/血液供给血管升压素类/投药和剂量血管升压素类/治疗应用青少年成年人老年人女(雌)性人类男(雄)性中年人

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Survival with full neurologic recovery and no cerebral pathology after prolonged cardiopulmonary resuscitation with vasopressin in pigs

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第2期35卷 527-533页

作者： Wenzel, V Lindner, KH Krismer, AC Voelckel, WG Schocke, MF Hund, W Witkiewicz, M Miller, EA Klima, G Wissel, J Lingnau, W Aichner, FT Univ Innsbruck Dept Anesthesiol & Crit Care Med A-6020 Innsbruck Austria Univ Innsbruck Dept Histol A-6020 Innsbruck Austria Univ Innsbruck Dept Neurol A-6020 Innsbruck Austria Univ Innsbruck Dept Magnet Resonance & Spect A-6020 Innsbruck Austria

OBJECTIVES We sought to determine the effects of vasopressin and saline placebo in comparison with epinephrine on neurologic recovery and possible cerebral pathology in an established porcine model of prolonged cardiopulmonary resuscitation (CPR). BACKGROUND It is unknown whether increased cerebral: blood flow during CPR with vasopressin is beneficial with regard to neurologic recovery or detrimental owing to complications such as cerebral edema after return of spontaneous circulation. METHODS After 4 min of cardiac arrest, followed by 3 min of basic life support CPR, 17 animals were randomly assigned to receive every 5 min either vasopressin (0.4, 0.4 and 0.8 U/kg;n = 6), epinephrine (45, 45 and 200 mu g/kg;n = 6) or saline placebo (n = 5). The mean value +/- SEM of aortic diastolic pressure was significantly (p < 0.05) higher 90 s after each of three vasopressin versus epinephrine versus saline placebo injections (60 +/- 3 vs. 45 +/- 3 vs. 29 +/- 2 mm Hg;49 +/- 5 vs. 27 +/- 3 vs. 23 +/- 1 mm Hg;and 50 +/- 6 vs. 21 +/- 3 vs. 16 +/- 3 mm Hg, respectively). After 22 min of cardiac arrest, including 18 min of CPR, defibrillation was attempted to achieve return of spontaneous circulation. RESULTS All the pigs that received epinephrine and saline placebo died, whereas all pigs on vasopressin survived (p < 0.05). Neurologic evaluation 24 h after successful resuscitation revealed only an unsteady gait in all vasopressin-treated animals;after 96 h, magnetic resonance imaging revealed no cerebral pathology. CONCLUSIONS During prolonged CPR, repeated vasopressin administration, but not epinephrine or saline placebo, ensured long-term survival with full neurologic recovery and no cerebral pathology in this porcine CPR model. (J Am Coll Cardiol 2000;35:527-33) (C) 2000 by the American College of Cardiology.

关键词：心肺复苏术/副作用心肺复苏术/方法脑血管循环/药物作用脑血管障碍/诊断脑血管障碍/病因学脑血管障碍/病理生理学脑血管障碍/预防和控制疾病模型动物电抗休克肾上腺素/治疗应用磁共振成像猪血管收缩药/治疗应用血管升压素类/治疗应用心室颤动/治疗动物

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ISOPROTERENOL IN OFFSETTING ADVERSE EFFECTS OF VASOPRESSIN IN CIRRHOTIC PATIENTS

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AMERICAN JOURNAL OF SURGERY 1975年第2期129卷 130-136页

作者： SIRINEK, KR THOMFORD, NR OHIO STATE UNIV COLL MEDDEPT SURGCOLUMBUSOH 43210

Vasopressin administered as a peripheral infusion (40 U/hr) significantly reduced portal vein pressure in ten awake patients with cirrhosis and portal hypertension. A vasopressin-induced reduction in cardiac output occurred in five of the ten patients (50 per cent). Vasopressin-induced changes in systemic arterial pressure, heart rate, and portal venous pressure were independent of alterations in cardiac output. When the five patients with vasopressin-induced reductions in cardiac output were given a combination of vasopressin and isoproterenol, cardiac output was maintained and the reduction in portal vein pressure was equal to that observed with unopposed vasopressin therapy. Thus, the addition of isoproterenol prevented a vasopressin-induced reduction in cardiac output while permitting vasopressin to reduce portal vein pressure.

关键词：血压/药物作用心排血量/药物作用药物评价食管和胃静脉曲张/药物疗法胃肠出血/药物疗法心率/药物作用输注胃肠外异丙肾上腺素/治疗应用肝硬化/并发症肝硬化/病理生理学门脉系统/药物作用血管升压素类/投药和剂量血管升压素类/治疗应用女(雌)性人类男(雄)性

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Vasopressin in the treatment of Milrinone-induced hypotension in severe heart failure

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期85卷 506-508页

作者： Gold, J Cullinane, S Chen, J Seo, S Oz, MC Oliver, JA Landry, DW Columbia Univ Coll Phys & Surg Dept Med New York NY 10032 USA Columbia Univ Coll Phys & Surg Dept Surg New York NY 10032 USA

Management of patients with severe heart failure and hemodynamic instability remains a difficult challenge. Phosphodiesterase (PDE) III inhibitors increase myocardial contractility and potentiate the inotropy of β agonists, and can be very useful in this setting.1–3 However, PDE III inhibitors also act in vascular smooth muscle to increase cyclic adenosine monophosphate and, via PDE IV inhibition, cyclic guanosine monophosphate.3,4 Although there is little response to these changes in normal subjects,5 in patients with severe heart failure and neurohumoral activation of adenylate and guanylate cyclases,6 PDE III inhibitors induce vasodilation and hypotension.7,8 A specific antagonist for the vascular action of PDE inhibitors could be clinically useful, and exogenous arginine vasopressin was of interest because this hormone inhibits activation of both adenylate cyclase and guanylate cyclase in vascular smooth muscle.9,10 Accordingly, we examined whether vasopressin at low doses, having no pressor effect in normal subjects, could maintain arterial pressure in patients with severe congestive heart failure receiving PDE III inhibitors.

关键词：血压/药物作用低血压/化学诱导低血压/药物疗法低血压/病理生理学注射静脉内米力农/治疗应用心肌收缩/药物作用磷酸二酯酶抑制剂/治疗应用肺楔压/药物作用回顾性研究治疗结果血管阻力/药物作用血管收缩药/投药和剂量血管收缩药/治疗应用血管升压素类/投药和剂量血管升压素类/治疗应用人类

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MESENTERIC ARTERIAL INFUSIONS OF VASOPRESSIN FOR HEMORRHAGE FROM COLONIC DIVERTICULOSIS

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AMERICAN JOURNAL OF SURGERY 1975年第2期129卷 212-216页

作者： ATHANASOULIS, CA BAUM, S ROSCH, J WALTMAN, AC RING, EJ SMITH, JC SUGARBAKER, E WOOD, W UNIV OREGON MED SCHDEPT RADIOLPORTLANDOR MASSACHUSETTS GEN HOSP DEPT SURGBOSTONMA 02114 MASSACHUSETTS GEN HOSP DEPT RADIOLBOSTONMA 02114

Twenty-four patients with massive rectal hemorrhage and known or subsequently proved colonic diverticular disease had the bleeding site localized by mesenteric angiography and received intra-arterial infusion of vasopressin to arrest the bleeding. In twenty-two patients the bleeding was controlled with the vasopressin infusion whereas in the remaining two, hemorrhage did not stop and surgery was performed. Of the twenty-two patients in whom bleeding was arrested by vasopressin infusion, twelve received no further surgical therapy, five had elective prophylactic surgical resection after a period of hemostasis, and the remaining five underwent segmental resection for bleeding that recurred after cessation of the infusion. Of the twelve patients who were not operated on, three had rebleeding two, four, and twelve months after vasopressin infusion and two of these three patients required surgery. The remaining nine have had no recurrent bleeding for periods ranging from seven to thirty-four months. Of ten patients who had segmental resection after precise localization of the bleeding site and initial control with vasopressin, no one has had recurrent hemorrhage for periods ranging from two to eighteen months.

关键词：憩室结肠/并发症评价研究随访研究胃肠出血/药物疗法输注胃肠外肠系膜动脉/放射摄影术复发血管升压素类/投药和剂量血管升压素类/治疗应用老年人女(雌)性人类男(雄)性

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Postresuscitation management

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ANNALS OF EMERGENCY MEDICINE 2001年第4期37卷 S182-S195页

作者： Schleien, CL Osmond, MH Hickey, R Hutchison, J Buunk, G Douglas, IS Gervais, HW Wenzel, V Columbia Univ New York Presbyterian Hosp New York NY 10032 USA Univ Pittsburgh Childrens Hosp Pittsburgh PA USA Univ Ottawa Childrens Hosp Eastern Ontario Ottawa ON Canada Franciscus Hosp Roosendaal Netherlands Univ Mainz D-6500 Mainz Germany Loeopold Franzens Univ Innsbruck Innsbruck Austria

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NEUROHYPOPHYSEAL HORMONES, ANALOGS, AND FRAGMENTS - THEIR EFFECT ON PUROMYCIN-INDUCED AMNESIA

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PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA 1975年第10期72卷 4180-4184页

作者： WALTER, R HOFFMAN, PL FLEXNER, JB FLEXNER, LB UNIV ILLINOIS MED CTR DEPT PHYSIOL CHICAGO IL 60612 USA UNIV PENN SCH MED DEPT ANAT PHILADELPHIA PA 19174 USA

Neurohypophyseal hormones and several of their analogs, as well as N-terminal and C-terminal fragments, have been studied for their ability to attenuate puromycin-induced amnesia in mice. [8-Lysine]vasopressin, [8-arginine]vasopressin, and the analogs des-9-glycinamide-[8-lysine]vasopressin, [1-beta-mercaptopropionic acid, 8-lysine]vasopressin, [1,6-aminosuberic acid, 8-lysine]vasopressin, [4-leucine, 8-lysine]vasopressin, glycyl-glycyl-glycyl-[8-lysine]vasopressin, [1-beta-mercaptopropionic acid, 8-D-arginine]vasopressin, and [1,6-aminosuberic acid, 8-arginine]vasopressin are active. [8-Arginine]oxytocin as well as oxytocin and all of its other analogs tested are inactive with the striking exception of glycyl-glycyl-glycyl-oxytocin. The structural aspects of the neurohypophyseal hormones which appear to be important for significant activity in memory consolidation include the combination of a cyclic moiety containing the Tyr and Phe residues along with a basic residue in position 8. Another series of active compounds comprises C-terminal neurohypophyseal peptides and analogs thereof, including the naturally occurring Pro-Leu-Gly-NH2 and, most surprisingly, Leu-Gly-NH2, as well as its derivatives D-Leu-Gly-NH2 and the diketopiperazine, cyclo(-Leu-Gly-).

关键词：遗忘/化学诱导遗忘/药物疗法脑/药物作用脑/生理学记忆/药物作用催产素/药理学催产素/治疗应用垂体激素类后叶/治疗应用嘌呤霉素构效关系血管升压素类/药理学血管升压素类/治疗应用加压催产素/药理学加压催产素/治疗应用动物人类小鼠

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Pharmacologic intervention during the acute bleeding episode

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Gastrointestinal Endoscopy Clinics of North America 1999年第2期9卷 287-299页

作者： Nader, A. Grace, N.D. Department of Gastroenterology Faulkner Hospital Boston MA 02130 1153 Centre Street United States

The risk of recurrent variceal bleeding after an acute episode of bleeding has been controlled in significant with rebleeding rates as high as 80% between one and two years. Pharmacologic therapy has a definite role in the prevention of recurrent variceal bleeding and should be started as soon as the acute bleeding event has been controlled. Serial hemodynamic measurements are critical for success. Non-selective beta-blocker therapy is a reasonable first line approach followed by the addition of a long-acting nitrate for patients not achieving a 20% reduction in the hepatic venous pressure gradient. Most patients will require combination pharmacotherapy or combined endoscopic therapy with pharmacotherapy.

关键词：急性病抗高血压药/治疗应用血流速度/药物作用药物疗法联合食管和胃静脉曲张/并发症食管和胃静脉曲张/药物疗法食管和胃静脉曲张/病理生理学胃肠出血/药物疗法胃肠出血/病因学胃肠出血/病理生理学激素类/治疗应用肝循环/药物作用赖氨酸加压素/类似物和衍生物赖氨酸加压素/治疗应用硝酸甘油/治疗应用门静脉压/药物作用危险因素生长抑素/治疗应用治疗结果血管收缩药/治疗应用血管舒张药/治疗应用血管升压素类/治疗应用人类

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