中国体外生命支持2025，Vol.23Issue(5)：388-393,6.DOI:10.13498/j.cnki.chin.j.ecls.2025.05.03
儿童复杂右心畸形体外循环术后血管加压素应用时机研究
A Prospective Randomized Controlled Study on the Optimal Timing of Vasopressin Initiation for Children with Complex Right Heart Malformation After Cardiopulmonary Bypass
摘要
Abstract
Objective To explore the optimal timing of vasopressin initiation for children with complex right heart mal-formation at high risk of vasoplegia after cardiopulmonary bypass:traditional use or early administration?Methods Children aged 1 month to 14 years with complex right heart malformations at high risk of vasoplegia after cardiopulmonary bypass at our pediatric cardiac center from January 1st to December 31st,2023 were prospectively enrolled in this study.The main types of the diseases included moderate to severe Tetralogy of Fallot(TOF),double outlet of the right ventricle with pulmonary stenosis(DORV/PS,TOF type),pulmonary atresia with ventricular septal defect(PAA/VSD).Patients were randomly divided into the early initiation group and the traditional initiation group based on the timing of vasopressin administration.In the early initiation group,vasopressin was given immediately upon return to the intensive care unit(ICU)after completing the systemic vascular re-sistance index(SVRI)measurement.In the traditional initiation group,vasopressin was given only if the following criteria were all met:vasoactive-inotropic score≥20,≥30 mL/kg of isotonic fluid resuscitation administered within 2 hours,and persistent hypotension despite ultrasound evaluation ruling out significant residual anatomical defects and severe ventricular dysfunction(Left Ventricular Ejection Fraction≤40%).The primary clinical outcomes(duration of mechanical ventilation and ICU length of stay)and the related clinical complications were compared between the two groups.Results A total of 169 pediatric patients were included in the final analysis:102 in the early initiation group and 67 in the traditional initiation group.The traditional initiation group exhibited a more pronounced state of vasoplegia prior to vasopressor initiation,with a significantly lower SVRI(899.7±283.1 dyn/s·cm-5·m-2)compared to the early initiation group(1012.7±282.8 dyn/s·cm-5·m-2;P=0.009).The early initiation group had a significantly shorter duration of mechanical ventilation[24(19,43)hours vs.39(21,71)hours,P=0.012]with a reduction of approximately 15 hours.Additionally,the ICU stay was significantly shorter with a reduction of approximate-ly 1.5 days[4(3,7)days vs.5.5(4,13.6)days,P=0.031].In terms of hemodynamics,the early initiation group took less time to achieve target circulation and negative fluid balance.There were no deaths in either group,and there was no significant difference in the incidence of associated complications(arrhythmia,pleural effusion,acute kidney injury and renal replacement therapy),and all patients were successfully discharged.Conclusion Early initiation of vasopressin is superior to traditional use in vaso-plegic shock for pediatric patients with complex right heart malformations after cardiopulmonary bypass.More stable hemody-namics,faster attainment of target circulation and negative fluid balance can be achieved,resulting in shorter duration of ventila-tor support and ICU stay without increasing associated complications.SVRI monitoring can be used as an important reference for the diagnosis of vasoplegia in children and has a good guiding role.关键词
血管麻痹/血管加压素/启用时机/儿童/先天性心脏病/复杂右心畸形Key words
vasoplegia/vasopressin/timing of initiation/children/congenital heart disease/complex right heart malformation引用本文复制引用
鲁中原,王澎,李宸钰,王晓峰,周宇子,姜亚洲,李泉林,王旭,李守军..儿童复杂右心畸形体外循环术后血管加压素应用时机研究[J].中国体外生命支持,2025,23(5):388-393,6.基金项目
高水平医院临床科研项目(2022-GSP-QN-13) （2022-GSP-QN-13）
高水平医院临床科研项目(2022-GSP-GG-32) （2022-GSP-GG-32）
