垂体后叶素在小儿心肺复苏中的应用研究

目的探讨垂体后叶素在小儿心肺复苏中的近期疗效。方法随机收集急诊科和ICU收治的心跳停搏患者201例，其中肾上腺素标准剂量组（对照组）111例，垂体后叶激素（含血管加压素）联合肾上腺素组（治疗组）90例。根据心跳停搏时间分为三组：心跳停搏1〉30min组、心跳停搏时间不详组和心跳停搏时间≤30min组。心跳停搏≤30min者又分成两组：单独重复使用（≥3次）的标准剂量肾上腺素（0．01mg／kg／次）组（标准对照组）32例，先单独使用标准剂量肾上腺素（0．01mg／kg／次），无效后加用垂体后叶激素为观察治疗组18例。治疗组随机分成甲、乙、丙三组：甲组：垂体后叶激素0．4U／kg／次，静脉注射；若无效每隔5min重复一次，肾上腺素剂量不变；垂体后叶激素剂量依次为0．6U／kg／次、0．8U／kg／次；乙组：垂体后叶激素0．6U／kg／次，若无效每隔5min重复一次，剂量依次为0．8U／kg／次、1U／kg／次；丙组：垂体后叶激素0．8U／kg／次，若无效每隔5min重复一次，剂量依次为1U／kg／次、1．2U／kg／次。各剂量组在注射3次复苏药后进行判断。结果各组病例多在2～3剂后见效并且复苏成功。少数注射3次复苏药后心跳不稳定或者无效，复苏时间〈30min，而不愿放弃者，继续使用复苏药。用第4剂复苏药的19例，其中初步复苏成功2例；用第5剂的仅1例，且无效。治疗组的初步复苏成功率（43．13％）和自主循环恢复率（37．25％）与对照组（45．9％、47．54％）比较差异均无统计学意义，Х^2=0．217、0．85，P〉0．05。虽然治疗组与对照组的疾病构成比略有差异，但治疗组的初步复苏成功率（26．67％）和自主循环恢复率（35．56％）与对照组（28．83％、30．63％）比较差异无统计学意义，Х^2=0．116、0．547，P〉0．05；心跳停搏≤30min对照组初步复苏成功率（45．9％）和自主循环恢复率（47．54％）与治疗组（37．25％、43．13％）比较差异无统计学意义，Х^2=0．217、0．85，P〉0．05。但观察治疗组初步复苏成功率（61．11％）高于标准对照组（25．00％），Х^2=6．38，P〈0．05。结论垂体后叶素联合肾上腺素对部分单独重复使用标准剂量肾上腺素无效的心搏骤停患儿有一定的近期复苏效果，其确切机制尚不明确。0．4～1．2U／kg的垂体后叶素与肾上腺素合用是有效且安全的，0．8u／kg的垂体后叶素静脉给药后的治疗效果相对明显。

Application of posterior pituitary hormone in pediatric cardiopulmonary resuscitation

Objective to investigate the effects of administration of posterior pituitary hormone （vasopressin,VAS） in pediatric cardiopulmonary resuscitation. Methods 201 pediatric patients with cardiopulmonary arrest, 130 male and 71 female, aged （9.13 ±1.29）months, admitted in the emergency department and ICU were randomly collected and divided into 2 groups： epinephrine standard-dose group （control group ）, 111 cases, and treatment group （90 case）. The patients of the control group underwent intravenous injection of epinephrine 0.0 1mg/kg, time and then 0.01 mg/kg every 5 min p.r.n. The cases of the treatment group were randomly divided into 3 groups： Group A undergoing intravenous injection of epinephrine 0.01 mg/kg/time and intravenous injection of posterior pituitary hormone 0.4 U/kg/time and then with the increasing doses of 0.4 U and 0.8 U/kg, combined with epinephrine group; Group B, undergoing intravenous injection of epinephrine and posterior pituitary hormone 0.6 U//kg/time and then with the increasing doses of 0.8 and 1.0 U//kg/time every 5 min p.r.n., and Group C undergoing intravenous injection of epinephrine 0.01 mg/kg/ time and intravenous injection of posterior pituitary hormone 0.8 U/kg/time and then with the increasing doses of 1.0 U and 1.2 U/kg, combined with epinephrine. The control group was given in standard-doses of epinephrine 0.01 mg/kg, intravenously, repeated every 5 minutes. According to cardiac arrest time the cases were divided into 3 groups： ≥30 minutes group, unknown time group and ≤30 minutes group. The≤30 minutes group were further divided into 2 groups： standard-doses control group （32 cases）undergoing only intravenous injection of standard-dose epinephrine for more than 3 times, and observation treatment group （18 cases）undergoing standard-dose epinephrine without effect and then undergoing intravenous injection of posterior pituitary hormone. The effects were evaluated after 3 times of injection of resuscitation drug. Results Curative effects was seen after 2-3 times of injection of resuscitation drug in most cases. 19 cases underwent 4 times of injection among which 2 cases showed initial success; and only 1 case underwent 5 times of injection, however, without success. The initial resuscitation success rate and rate of return of spontaneous circulation （ROSC） of the treatment group were 26.67% and 35.56% respectively, both not significantly different from those of the control group （28.83% and 30.63% respectively）, Х^2=0.116,0.547, both P 〉0.05.There were no significant statistical differences in initial resuscitation success rate and ROSC rate between the cardiac arrest ≤30 minutes control group and observation treatment group （45.9% and 47.54% vs. 37.25% and 43.13%）, Х^2=0.217,0.85, both P 〉 0.05. However, the initial resuscitation success rate of the cardiac arrest ≤30 minutes observation treatment group was 61.11%, significantly higher than that of the standard-doses control group （25.00%）, Х^2 =6.38, P 〈0.05. Conclusion Posterior pituitary hormone combined with epinephrine has considerable resuscitation effect on pediatric patients with refractory cardiac arrest that is not responsive to standard dose epinephrine. P posterior pituitary hormone with the doses 0.4 U-1.2 U/kg combined with epinephrine is effective and safe. Intravenous injection of posterior pituitary hormone at the dose of 0.8 U/kg is relatively effective.