切换至 "中华医学电子期刊资源库"

中华危重症医学杂志(电子版) ›› 2024, Vol. 17 ›› Issue (04) : 331 -335. doi: 10.3877/cma.j.issn.1674-6880.2024.04.011

综述

亚甲蓝改善脓毒性休克患者血流动力学和组织灌注的研究进展
贾进鑫1, 吉晶晶2, 刘志锋2,()   
  1. 1. 510515 广州,南方医科大学第一临床医学院;510010 广州,中国人民解放军南部战区总医院MICU科
    2. 510010 广州,中国人民解放军南部战区总医院MICU科
  • 收稿日期:2023-07-20 出版日期:2024-08-31
  • 通信作者: 刘志锋
  • 基金资助:
    国家自然科学基金项目(82072143); 军队后勤科研项目(BLJ20J006)
  • Received:2023-07-20 Published:2024-08-31
引用本文:

贾进鑫, 吉晶晶, 刘志锋. 亚甲蓝改善脓毒性休克患者血流动力学和组织灌注的研究进展[J]. 中华危重症医学杂志(电子版), 2024, 17(04): 331-335.

脓毒症是指由于宿主对感染的反应失调导致的危及生命的器官功能障碍。脓毒性休克则是指脓毒症经过充分的液体复苏,仍然无法维持平均动脉压(mean artery pressure,MAP)在65 mmHg(1 mmHg = 0.133 kPa)以上,并伴随循环和细胞代谢异常,病死率极高[1]。脓毒性休克是重症监护室中重要的死亡原因之一,2017年全世界约发生了4 890万脓毒症病例[2],约15%的脓毒症发展为脓毒性休克,占ICU病例的10%[3]。尽管有拯救脓毒症运动的推广、治疗措施的不断优化,脓毒性休克的病死率依然居高不下。根据最近的一项Meta分析,脓毒性休克患者的90 d病死率依然高达38.5%[4]。难治性脓毒性休克的患者病死率甚至高达60%[5]

1
Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021[J]. Crit Care Med, 2021, 49 (11): e1063-e1143.
2
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study[J]. Lancet, 2020, 395 (10219): 200-211.
3
Dugar S, Choudhary C, Duggal A. Sepsis and septic shock: guideline-based management[J]. Cleve Clin J Med, 2020, 87 (1): 53-64.
4
Bauer M, Gerlach H, Vogelmann T, et al. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019—results from a systematic review and meta-analysis[J]. Crit Care, 2020, 24 (1): 239.
5
Nandhabalan P, Ioannou N, Meadows C, et al. Refractory septic shock: our pragmatic approach[J]. Crit Care, 2018, 22 (1): 215.
6
Russell JA. Vasopressor therapy in critically ill patients with shock[J]. Intensive Care Med, 2019, 45 (11): 1503-1517.
7
刘秦杰,吴婕,吴秀文,等.脓毒症患者铁代谢紊乱的研究进展[J/CD].中华危重症医学杂志(电子版)202215(6):495-499.
8
Cinelli MA, Do HT, Miley GP, et al. Inducible nitric oxide synthase: regulation, structure, and inhibition[J]. Med Res Rev, 2020, 40 (1): 158-189.
9
Minhas R, Bansal Y, Bansal G. Inducible nitric oxide synthase inhibitors: a comprehensive update[J]. Med Res Rev, 2020, 40 (3): 823-855.
10
Martin E, Davis K, Bian K, et al. Cellular signaling with nitric oxide and cyclic guanosine monophosphate[J]. Semin Perinatol, 2000, 24 (1): 2-6.
11
Carvajal JA, Germain AM, Huidobro-Toro JP, et al. Molecular mechanism of cGMP-mediated smooth muscle relaxation[J]. J Cell Physiol, 2000, 184 (3): 409-420.
12
Bolotina VM, Najibi S, Palacino JJ, et al. Nitric oxide directly activates calcium-dependent potassium channels in vascular smooth muscle[J]. Nature, 1994, 368 (6474): 850-853.
13
López A, Lorente JA, Steingrub J, et al. Multiple-center, randomized, placebo-controlled, double-blind study of the nitric oxide synthase inhibitor 546C88: effect on survival in patients with septic shock[J]. Crit Care Med, 2004, 32 (1): 21-30.
14
Cobb JP, Natanson C, Hoffman WD, et al. N omega-amino-L-arginine, an inhibitor of nitric oxide synthase, raises vascular resistance but increases mortality rates in awake canines challenged with endotoxin[J]. J Exp Med, 1992, 176 (4): 1175-1182.
15
Puntillo F, Giglio M, Pasqualucci A, et al. Vasopressor-sparing action of methylene blue in severe sepsis and shock: a narrative review[J]. Adv Ther, 2020, 37 (9): 3692-3706.
16
Wolin MS, Cherry PD, Rodenburg JM, et al. Methylene blue inhibits vasodilation of skeletal muscle arterioles to acetylcholine and nitric oxide via the extracellular generation of superoxide anion[J]. J Pharmacol Exp Ther, 1990, 254 (3): 872-876.
17
Salaris SC, Babbs CF, Voorhees WD 3rd. Methylene blue as an inhibitor of superoxide generation by xanthine oxidase. A potential new drug for the attenuation of ischemia/reperfusion injury[J]. Biochem Pharmacol, 1991, 42 (3): 499-506.
18
Kelner MJ, Bagnell R, Hale B, et al. Methylene blue competes with paraquat for reduction by flavo-enzymes resulting in decreased superoxide production in the presence of heme proteins[J]. Arch Biochem Biophys, 1988, 262 (2): 422-426.
19
Keaney JF Jr, Puyana JC, Francis S, et al. Methylene blue reverses endotoxin-induced hypotension[J]. Circ Res, 1994, 74 (6): 1121-1125.
20
Birch AA, Boyce WH. Hypertension and decreased renal blood flow following methylene blue injection[J]. Anesth Analg, 1976, 55 (5): 674-676.
21
Schneider F, Lutun P, Hasselmann M, et al. Methylene blue increases systemic vascular resistance in human septic shock. Preliminary observations[J]. Intensive Care Med, 1992, 18 (5): 309-311.
22
Preiser JC, Lejeune P, Roman A, et al. Methylene blue administration in septic shock: a clinical trial[J]. Crit Care Med, 1995, 23 (2): 259-264.
23
Daemen-Gubbels CR, Groeneveld PH, Groeneveld AB, et al. Methylene blue increases myocardial function in septic shock[J]. Crit Care Med, 1995, 23 (8): 1363-1370.
24
Gachot B, Bedos JP, Veber B, et al. Short-term effects of methylene blue on hemodynamics and gas exchange in humans with septic shock[J]. Intensive Care Med, 1995, 21 (12): 1027-1031.
25
Andresen M, Dougnac A, Díaz O, et al. Use of methylene blue in patients with refractory septic shock: impact on hemodynamics and gas exchange[J]. J Crit Care, 1998, 13 (4): 164-168.
26
Weingartner R, Oliveira E, Oliveira ES, et al. Blockade of the action of nitric oxide in human septic shock increases systemic vascular resistance and has detrimental effects on pulmonary function after a short infusion of methylene blue[J]. Braz J Med Biol Res, 1999, 32 (12): 1505-1513.
27
Kirov MY, Evgenov OV, Evgenov NV, et al. Infusion of methylene blue in human septic shock: a pilot, randomized, controlled study[J]. Crit Care Med, 2001, 29 (10): 1860-1867.
28
Memis D, Karamanlioglu B, Yuksel M, et al. The influence of methylene blue infusion on cytokine levels during severe sepsis[J]. Anaesth Intensive Care, 2002, 30 (6): 755-762.
29
黄明夏,谭道全,方珍琼.亚甲蓝对小儿感染性休克血液动力学和氧代谢影响的临床观察[J].小儿急救医学200310(6):365-367.
30
Park BK, Shim TS, Lim CM, et al. The effects of methylene blue on hemodynamic parameters and cytokine levels in refractory septic shock[J]. Korean J Intern Med, 2005, 20 (2): 123-128.
31
Juffermans NP, Vervloet MG, Daemen-Gubbels CR, et al. A dose-finding study of methylene blue to inhibit nitric oxide actions in the hemodynamics of human septic shock[J]. Nitric Oxide, 2010, 22 (4): 275-280.
32
Donati A, Conti G, Loggi S, et al. Does methylene blue administration to septic shock patients affect vascular permeability and blood volume?[J]. Crit Care Med, 2002, 30 (10): 2271-2277.
33
陆雅萍,刘倩影,郁慧杰.亚甲蓝对感染性休克患者动脉血气值和氧灌注指数的影响[J].浙江医学201941(6):575-578.
34
熊响清,金立达,王良荣,等.亚甲蓝对感染性休克患者术中氧代谢的影响[J].中华麻醉学杂志201030(10):1239-1242.
35
陆雅萍,郁惠杰,刘倩影,等.亚甲蓝持续静脉输注对感染性休克患者的治疗效果[J].中华医学杂志201999(11):868-871.
36
Brown G, Frankl D, Phang T. Continuous infusion of methylene blue for septic shock[J]. Postgrad Med J, 1996, 72 (852): 612-614.
37
van Haren FMP, Pickkers P, Foudraine N, et al. The effects of methylene blue infusion on gastric tonometry and intestinal fatty acid binding protein levels in septic shock patients[J]. J Crit Care, 2010, 25 (2): 358.e1-358.e7.
38
Avontuur JA, Stam TC, Jongen-Lavrencic M, et al. Effect of L-NAME, an inhibitor of nitric oxide synthesis, on plasma levels of IL-6, IL-8, TNF alpha and nitrite/nitrate in human septic shock[J]. Intensive Care Med, 1998, 24 (7): 673-679.
39
Heemskerk S, van Haren FM, Foudraine NA, et al. Short-term beneficial effects of methylene blue on kidney damage in septic shock patients[J]. Intensive Care Med, 2008, 34 (2): 350-354.
40
Ismail R, Awad H, Allam R, et al. Methylene blue versus vasopressin analog for refractory septic shock in the preterm neonate: a randomized controlled trial[J]. J Neonatal Perinatal Med, 2022, 15 (2): 265-273.
41
Domínguez-Rojas JA, Caqui P, Sanchez A, et al. Methylene blue for the treatment of refractory septic shock secondary to listeriosis in a paediatric patient[J]. BMJ Case Rep, 2022, 15 (2): e243772.
42
Rutledge C, Brown B, Benner K, et al. A novel use of methylene blue in the pediatric ICU[J]. Pediatrics, 2015, 136 (4): e1030-1034.
43
Peter C, Hongwan D, Küpfer A, et al. Pharmacokinetics and organ distribution of intravenous and oral methylene blue[J]. Eur J Clin Pharmacol, 2000, 56 (3): 247-250.
44
Evora PRB, Ribeiro PJ, Vicente WV, et al. Methylene blue for vasoplegic syndrome treatment in heart surgery: fifteen years of questions, answers, doubts and certainties[J]. Rev Bras Cir Cardiovasc, 2009, 24 (3): 279-288.
45
Jaiswal A, Kumar M, Silver E. Extended continuous infusion of methylene blue for refractory septic shock[J]. Indian J Crit Care Med, 2020, 24 (3): 206-207.
46
Dumbarton TC, Minor S, Yeung CK, et al. Prolonged methylene blue infusion in refractory septic shock: a case report[J]. Can J Anaesth, 2011, 58 (4): 401-405.
47
Dumbarton TC, Gorman SK, Minor S, et al. Local cutaneous necrosis secondary to a prolonged peripheral infusion of methylene blue in vasodilatory shock[J]. Ann Pharmacother, 2012, 46 (3): e6.
No related articles found!
阅读次数
全文


摘要