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عمومی::
وازوپرسور، وازوپرسور
The information in the follow- ing paragraphs and in Table 11.2 emphasizes data obtained from investigations of vasopressors in intact preparations, and gives priority to the results obtained in humans and higher primates.
Vasopressors affect both arterial and venous tone.
In patients with a head injury, the admin- istration of phenylephrine increased CPP and did not reduce regional CBF.36 Transient changes may occur in CBF and rSO2 (on the order of 2-5 minutes) in response to bolus doses of phenylephrine; however, with a continuous infusion, a1- agonists have little direct influence on CBF and cerebral oxy- genation in humans.34 Thus maintenance of CPP with these vasopressors does not have an adverse effect on the brain.
Angiotensin II, Angiotensin-Converting Enzyme Inhibitors, and Angiotensin Receptor Antagonists There has been a renaissance of the use of angiotensin II (AII) for the treatment of vasodilatory shock that is refrac- tory to conventional vasopressor agents.
In these shock states, AII increased MAP and reduced the need for other vasopressors including norepinephrine and vasopres- sin.،Vasopressors after the shock.
No known vasopressor (epinephrine) increases survival from VF/pulseless VT.
Although no clinical study has examined whether titrating resuscitative efforts to physiologic parameters improves outcome, it is reasonable to use these parameters, if available, to optimize compressions and guide vasopressor therapy during cardiac arrest.
• If the PETCO2 is less than 10 mm Hg during CPR, it is reasonable to try to improve chest compressions and vasopressor therapy.
• If the arterial relaxation pressure is less than 20 mm Hg (Figure 36B), it is reasonable to try to improve chest compressions and vasopressor therapy.
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