感染性休克仍然是危重病人发病和死亡的主要原因之一。尽管进行了早期目标治疗并给予了链胆胺能药物,但仍有高达30%的患者死于该疾病。在这份手稿中,我们首先总结了感染性休克患者的护理标准和当前的指南。我们回顾了加压素的生理作用及其在脓毒性休克管理中的作用。然后,我们回顾了关于V1a受体激动剂(如加压素)在感染性休克中潜在作用的最新证据。令人兴奋的新试验正在完成,以阐明V1a受体激动剂作为潜在的一线血管加压药替代品在脓毒症患者循环休克治疗中的作用。Septic shock remains one of the major causes of morbidity and mortality in the critically ill. Despite early goal therapy and administration of cathecholaminergic agents, up to 30% of patients succumb to the disease. In this manuscript, we first summarize the standard of care of patients with septic shock and current guidelines. We review the physiologic role of vasopressin and its role in septic shock management. We then review the most up-to-date evidence on the potential role of V1a receptor agonists such as Selepressin, in septic shock. Exciting new trials are being completed in order to elucidate the role of V1a receptor agonists as potential first-line vasopressor alternatives in the therapy of circulatory shock in septic patients.
背景:全球脓毒症休克的发病率和死亡率居高不下,尽管去甲肾上腺素可以增加危重病人的血压,但对额外治疗的需求未得到满足。方法:特利加压素与去甲肾上腺素治疗感染性休克的多中心随机对照试验来解决这个问题。结果:将617例患者随机分配到特利加压素(n = 312)或去甲肾上腺素输注(n = 305)联合标准治疗组,其中包括开放标签血管加压药。对主要终点,即亚组28天死亡率(特利加压素n = 260;去甲肾上腺素n = 266)进行了先验改良的意向治疗初步分析。28天死亡率无差异(特利加压素 = 40%,去甲肾上腺素 = 38%,p NS)。选定的次要终点,如存活天数和无血管加压药天数以及脓毒症器官衰竭评估(SOFA)评分的变化,组间没有差异。然而,特利加压素组的不良事件比去甲肾上腺素组更严重(30% vs. 12%, P Background: The incidence and mortality of septic shock remain high globally, and although norepinephrine can increase blood pressure in critically ill patients, there is an unmet need for additional treatment. Methods: A multicenter randomized controlled trial of teripressin versus norepinephrine for septic shock was conducted to address this issue. Results: 617 patients were randomly assigned to teripressin (n = 312) or norepinephrine infusion (n = 305) in combination with standard care, which included open-label vasopressors. For the primary endpoint, the subgroup 28-day mortality (teripressin n = 260;Norepinephrine n = 266) performed a preliminary analysis of intention-to-treat with a priori modification. There was no difference in mortality at 28 days (teripressin = 40%, norepinephrine = 38%, pNS). Selected secondary endpoints, such as days of survival and vasopressor free days and changes in the Sepsis Organ Failure Assessment (SOFA) score, did not differ between groups. However, adverse events were more severe in the teripressin group than in the norepinephrine group (30% vs. 12%, P < 0.01). Conclusions: There was no difference
