急性脊髓损伤后盐酸卓希多巴用于血压升高:病例报告。

IF 2 Q3 CRITICAL CARE MEDICINE
Acute and Critical Care Pub Date : 2025-02-01 Epub Date: 2022-12-07 DOI:10.4266/acc.2021.01662
Christopher S Hong, Muhammad K Effendi, Abdalla A Ammar, Kent A Owusu, Mahmoud A Ammar, Andrew B Koo, Layton A Lamsam, Aladine A Elsamadicy, Gregory A Kuzmik, Maxwell Laurans, Michael L DiLuna, Mark L Landreneau
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引用次数: 0

摘要

低血压继发于自主神经功能障碍是急性脊髓损伤(SCI)的常见并发症,可使神经系统预后恶化。Midodrine是一种肠内α-1激动剂,常用于促进静脉(IV)加压药物的断奶,但其使用可能因反射性心动过缓而受到限制。在急性脊髓损伤后的情况下,替代肠内药物促进断奶尚未被描述。我们的目的是描述droxidopa的新应用,一种去甲肾上腺素的肠内前体,被批准用于治疗神经源性直立性低血压,急性脊髓损伤后设置。对于因反射性心动过缓而不能耐受midodrine的患者,Droxidopa可能是另一种肠内治疗方法。我们描述了两例外伤性颈椎脊髓损伤的患者,他们在使用米多宁失败后,成功地停用静脉血管加压药物羟西多巴。第一位患者是一名64岁的男性,他在10英尺高处跌倒导致四肢瘫痪后接受了C3-6椎板切除术和融合术。术后,在试图戒断静脉血管加压药的情况下,加入米多卡因导致明显的反射性心动过缓。用盐酸卓希多巴治疗有助于迅速停用静脉血管加压药物,并在治疗开始的72小时内转入较低水平的护理。第二位患者是一名73岁男性,因外伤性过度屈曲损伤导致截瘫,接受了C3-5椎板切除术和融合术。midodrine的加入导致严重的心动过缓,促使考虑放置起搏器。然而,随着氯希多巴的加入,这种情况得以避免,患者在米多宁和氯希多巴的双重口服治疗中停用静脉加压药物。对于急性脊髓损伤后不能耐受midodrine以戒除静脉加压药物的患者,Droxidopa可能是一种可行的肠内治疗低血压的方法。这种策略可以避免放置起搏器,并缩短重症监护病房的住院时间,特别是对于那些病情稳定但需要继续入住重症监护病房接受静脉血管加压药物治疗的患者,这可能是成本无效和人力资源消耗的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of droxidopa for blood pressure augmentation after acute spinal cord injury: case reports.

Hypotension secondary to autonomic dysfunction is a common complication of acute spinal cord injury (SCI) that may worsen neurologic outcomes. Midodrine, an enteral α-1 agonist, is often used to facilitate weaning intravenous (IV) vasopressors, but its use can be limited by reflex bradycardia. Alternative enteral agents to facilitate this wean in the acute post-SCI setting have not been described. We aim to describe novel application of droxidopa, an enteral precursor of norepinephrine that is approved to treat neurogenic orthostatic hypotension, in the acute post-SCI setting. Droxidopa may be an alternative enteral therapy for those intolerant of midodrine due to reflex bradycardia. We describe two patients suffering traumatic cervical SCI who were successfully weaned off IV vasopressors with droxidopa after failing with midodrine. The first patient was a 64-year-old male who underwent C3-6 laminectomies and fusion after a ten-foot fall resulting in quadriparesis. Post-operatively, the addition of midodrine in an attempt to wean off IV vasopressors resulted in significant reflexive bradycardia. Treatment with droxidopa facilitated rapidly weaning IV vasopressors and transfer to a lower level of care within 72 hours of treatment initiation. The second patient was a 73-year-old male who underwent C3-5 laminectomies and fusion for a traumatic hyperflexion injury causing paraplegia. The addition of midodrine resulted in severe bradycardia, prompting consideration of pacemaker placement. However, with the addition of droxidopa, this was avoided, and the patient was weaned off IV vasopressors on dual oral therapy with midodrine and droxidopa. Droxidopa may be a viable enteral therapy to treat hypotension in patients after acute SCI who are otherwise not tolerating midodrine in order to wean off IV vasopressors. This strategy may avoid pacemaker placement and facilitate shorter stays in the intensive care unit, particularly for patients who are stable but require continued intensive care unit admission for IV vasopressors, which can be cost ineffective and human resource depleting.

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来源期刊
Acute and Critical Care
Acute and Critical Care CRITICAL CARE MEDICINE-
CiteScore
2.80
自引率
11.10%
发文量
87
审稿时长
12 weeks
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