灌注压的维持:缩血管药物如何选择?  

Maintenance of Perfusion Pressure: How to Choose the Vasoconstriction Drugs?

作　　者：管向东[1] 刘紫锰[1] GUAN Xiang-dong;LIU Zi-meng(Department of Critical Care Medicine,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院重症医学科

出　　处：《协和医学杂志》2019年第5期456-460,共5页Medical Journal of Peking Union Medical College Hospital

摘　　要：休克是临床常见的重症状态,可迅速进展为多器官功能衰竭,病死率高。应用缩血管药物是休克治疗中维持灌注压的重要措施,儿茶酚胺类药物是目前最常用的选择,去甲肾上腺素是多数休克状态下的首要选择,血管加压素及其类似物、血管紧张素Ⅱ均能有效维持灌注压、减少去甲肾上腺素用量,也是临床上维持灌注压可选择的药物。根据不同休克类型、病因及不同药物作用机制选择缩血管药物,对优化血流动力学治疗及减少不良反应尤为重要。Shock is a common critical condition of numerous diseases,resulting in multi-organ dysfunction and death.Vasopressors are the essential part of shock management.Catecholamines are the most commonly used vasopressors in the intensive care unit,among which norepinephrine is the first-line therapy in most clinical conditions.Vasopressin and angiotensinⅡmay be useful owing to their norepinephrine-sparing effects.Careful selection of vasoconstriction drugs based on desired pharmacologic effects that are matched to the patient’s underlying pathophysiology of shock may optimize hemodynamics while reducing the potential for adverse effects.

关 键 词：休克 缩血管药物 去甲肾上腺素 血管加压素 血管紧张素 

分 类 号：R441.9[医药卫生—诊断学] R453[医药卫生—临床医学]