Memis D, Karamanlioglu B, Yuksel M, Gemlik I, Pamukcu Z
Department of Anaesthesiology and Reanimation, Medical Faculty, Trakya University, 22030 Edirne, Turkey.
Anaesth Intensive Care. 2002 Dec;30(6):755-62. doi: 10.1177/0310057X0203000606.
The aim of our study was to assess the effect of methylene blue infusion on plasma levels of cytokines in severe sepsis. In a prospective, randomized, double-blind, placebo-controlled study, patients received either methylene blue 0.5 mg.kg-1.h-1 (MB group, n = 15) or similar volume of isotonic saline (control group, n = 15) i.v. for 6 hours. Plasma concentrations of tumour necrosis factor-alpha, interleukin-1, interleukin-2 receptor, interleukin-6, interleukin-8 were measured by sensitive immunoassays at basal (15 min before start of the study), immediately after, and at 24 and 48 hours after methylene blue infusion. We evaluated haemodynamic parameters (mean arterial pressure, heart rate), blood gases, methaemoglobin levels, and biochemical parameters at the same time. Methylene blue administration had no significant effect on plasma cytokine levels, blood gases and biochemical parameters. When compared to placebo infusion in controls, methylene blue administration resulted in significantly higher mean arterial pressure (85 +/- 14 mmHg vs 74.1 +/- 10.3 mmHg; P < 0.01), and methaemoglobin levels (1.06 +/- 0.22% vs 0.9 +/- 0.05%; P < 0.05). Furthermore, comparison with baseline levels revealed significantly increased both mean arterial pressure (85 +/- 14 mmHg and 74.1 +/- 10.2 mmHg; P < 0.05) and methaemoglobin levels (1.06 +/- 0.22% and 0.88 +/- 0.06%; P < 0.05) in MB group. There was no difference in mortality rates between the groups. We found that methylene blue infusion did not change cytokine levels or outcome in severe sepsis. The administration of methylene blue, however, resulted in a transient increase in arterial pressure. Because of the limited size of the present study, and the short period of observation, our findings need to be confirmed by larger clinical trials of methylene blue infused in a dose-titrated manner.
我们研究的目的是评估亚甲蓝输注对严重脓毒症患者血浆细胞因子水平的影响。在一项前瞻性、随机、双盲、安慰剂对照研究中，患者静脉输注亚甲蓝0.5 mg·kg-1·h-1（MB组，n = 15）或等体积的等渗盐水（对照组，n = 15），持续6小时。在基础状态（研究开始前15分钟）、输注亚甲蓝后即刻、输注后24小时和48小时，通过灵敏的免疫测定法测量血浆中肿瘤坏死因子-α、白细胞介素-1、白细胞介素-2受体、白细胞介素-6、白细胞介素-8的浓度。同时我们评估血流动力学参数（平均动脉压、心率）、血气、高铁血红蛋白水平和生化参数。亚甲蓝给药对血浆细胞因子水平、血气和生化参数无显著影响。与对照组输注安慰剂相比，亚甲蓝给药导致平均动脉压显著升高（85±14 mmHg对74.1±10.3 mmHg；P < 0.01），高铁血红蛋白水平升高（1.06±0.22%对0.9±0.05%；P < 0.05）。此外，与基线水平比较显示MB组平均动脉压（85±14 mmHg和74.1±10.2 mmHg；P < 0.05）和高铁血红蛋白水平（1.06±0.22%和0.88±0.06%；P < 0.05）均显著升高。两组间死亡率无差异。我们发现亚甲蓝输注不会改变严重脓毒症患者的细胞因子水平或预后。然而，亚甲蓝给药导致动脉压短暂升高。由于本研究规模有限且观察期较短，我们的研究结果需要通过更大规模的以剂量滴定方式输注亚甲蓝的临床试验来证实。
