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Vasopressin and its analogues in shock states: a review.
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2020-01-22 , DOI: 10.1186/s13613-020-0628-2
Julien Demiselle 1 , Nicolas Fage 1 , Peter Radermacher 2 , Pierre Asfar 1
Affiliation  

Activation of arginine-vasopressin is one of the hormonal responses to face vasodilation-related hypotension. Released from the post-pituitary gland, vasopressin induces vasoconstriction through the activation of V1a receptors located on vascular smooth muscle cells. Due to its non-selective receptor affinity arginine-vasopressin also activates V2 (located on renal tubular cells of collecting ducts) and V1b (located in the anterior pituitary and in the pancreas) receptors, thereby potentially promoting undesired side effects such as anti-diuresis, procoagulant properties due to release of the von Willebrand's factor and platelet activation. Finally, it also cross-activates oxytocin receptors. During septic shock, vasopressin plasma levels were reported to be lower than expected, and a hypersensitivity to its vasopressor effect is reported in such situation. Terlipressin and selepressin are synthetic vasopressin analogues with a higher affinity for the V1 receptor, and, hence, potentially less side effects. In this narrative review, we present the current knowledge of the rationale, benefits and risks of vasopressin use in the setting of septic shock and vasoplegic shock following cardiac surgery. Clearly, vasopressin administration allows reducing norepinephrine requirements, but so far, no improvement of survival was reported and side effects are frequent, particularly ischaemic events. Finally, we will discuss the current indications for vasopressin and its agonists in the setting of septic shock, and the remaining unresolved questions.

中文翻译:

血管加压素及其类似物在休克状态:综述。

精氨酸加压素的激活是对面部血管舒张相关性低血压的激素反应之一。血管加压素从垂体后腺中释放出来,通过激活位于血管平滑肌细胞上的V1a受体来诱导血管收缩。由于其非选择性受体亲和力,精氨酸加压素还激活V2(位于收集管的肾小管细胞上)和V1b(位于垂体前叶和胰腺中)受体,从而潜在地促进了不良反应,例如抗利尿作用,由于von Willebrand因子的释放和血小板活化而具有促凝血特性。最后,它还可以使催产素受体交叉活化。在败血性休克期间,血管加压素的血浆水平据报道低于预期,并且在这种情况下据报道对其血管升压作用过敏。特利加压素和硒代加压素是合成的血管加压素类似物,对V1受体具有更高的亲和力,因此副作用可能更少。在本篇叙述性综述中,我们介绍了在心脏手术后发生感染性休克和血管性肢体休克的情况下使用加压素的基本原理,益处和风险。显然,加压素的给药可以减少去甲肾上腺素的需求,但是到目前为止,尚无存活率的报道,而且副作用频繁发生,尤其是缺血性事件。最后,我们将讨论败血性休克背景下加压素及其激动剂的当前适应症,以及尚待解决的问题。特利加压素和硒代加压素是合成的血管加压素类似物,对V1受体具有更高的亲和力,因此副作用可能更少。在本篇叙述性综述中,我们介绍了在心脏手术后发生感染性休克和血管性肢体休克的情况下使用加压素的基本原理,益处和风险。显然,加压素的给药可以减少去甲肾上腺素的需求,但是到目前为止,尚无存活率的报道,而且副作用频繁发生,尤其是缺血性事件。最后,我们将讨论败血性休克背景下加压素及其激动剂的当前适应症,以及尚待解决的问题。特利加压素和硒代加压素是合成的血管加压素类似物,对V1受体具有更高的亲和力,因此副作用可能更少。在本篇叙述性综述中,我们介绍了在心脏手术后发生感染性休克和血管性肢体休克的情况下使用加压素的基本原理,益处和风险。显然,加压素的给药可以减少去甲肾上腺素的需求,但是到目前为止,尚无存活率的报道,而且副作用频繁发生,尤其是缺血性事件。最后,我们将讨论败血性休克背景下加压素及其激动剂的当前适应症,以及尚待解决的问题。在心脏手术后出现败血性休克和血管性肢体性休克时使用加压素的益处和风险。显然,加压素的给药可以减少去甲肾上腺素的需求,但是到目前为止,尚无存活率的报道,而且副作用频繁发生,尤其是缺血性事件。最后,我们将讨论败血症性休克背景下加压素及其激动剂的当前适应症,以及尚待解决的问题。在心脏手术后出现败血性休克和血管性肢体性休克时使用加压素的益处和风险。显然,加压素的给药可以减少去甲肾上腺素的需求,但是到目前为止,尚无存活率的报道,而且副作用频繁发生,尤其是缺血性事件。最后,我们将讨论败血性休克背景下加压素及其激动剂的当前适应症,以及尚待解决的问题。
更新日期:2020-01-23
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