Liệu pháp angiotensin II trong sốc nhiễm khuẩn kháng trị: Bệnh nhân nào có thể được lợi ích nhiều nhất? Một bài tổng quan

Irene Coloretti1, Andrea Genovese1, J. Pedro Teixeira2, Anusha Cherian3, Ricard Ferrer4, Giovanni Landoni5, Marc Leone6, Massimo Girardis1, Nathan D. Nielsen7
1Anesthesia and Intensive Care Medicine, Policlinico Di Modena, University of Modena and Reggio Emilia, Modena, Italy
2Divisions of Nephrology and Pulmonary, Critical Care, and Sleep Medicine, University of New Mexico School of Medicine, Albuquerque, USA
3Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
4Intensive Care Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
5Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
6Anesthesia and Intensive Care Medicine, Hôpital Nord, Assistance Publique Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
7Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA

Tóm tắt

Bệnh nhân bị sốc nhiễm khuẩn gặp phải huyết áp thấp kháng trị bất chấp việc hồi sức dịch đầy đủ và sử dụng norepinephrine liều cao có tỷ lệ tử vong cao. Để cải thiện kết quả, các hướng dẫn dựa trên chứng cứ khuyến cáo bắt đầu sử dụng một vasopressor thứ hai, chẳng hạn như vasopressin, nếu liều norepinephrine vượt quá 0,5 µg/kg/phút. Gần đây, các kết quả đầy hứa hẹn đã được quan sát trong việc điều trị huyết áp thấp kháng trị bằng angiotensin II, cho thấy nó có tác dụng tăng áp lực động mạch trung bình và có liên quan đến việc cải thiện kết quả lâm sàng. Bài tổng quan này nhằm cung cấp cái nhìn tổng quan về sinh lý bệnh của hệ thống renin-angiotensin và vai trò của angiotensin II nội sinh trong sốc giãn mạch, với trọng tâm là cách điều trị bằng angiotensin II ảnh hưởng đến kết quả lâm sàng và xác định quần thể có thể hưởng lợi nhiều nhất từ việc sử dụng nó.

Từ khóa

#sốc nhiễm khuẩn #huyết áp thấp kháng trị #norepinephrine #vasopressor #angiotensin II #hồi sức dịch

Tài liệu tham khảo

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