Leyh Rainer G, Kofidis Theo, Strüber Martin, Fischer Stefan, Knobloch Karsten, Wachsmann Bjoern, Hagl Christian, Simon Andre R, Haverich Axel
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.
J Thorac Cardiovasc Surg. 2003 Jun;125(6):1426-31. doi: 10.1016/s0022-5223(02)73284-4.
Vasoplegia is a frequent complication after cardiopulmonary bypass that often requires the application of norepinephrine. In a number of cases, however, vasoplegia is refractory to norepinephrine. The guanylate cyclase inhibitor methylene blue could be an attractive treatment alternative in such cases. This study examines the results of methylene blue therapy for norepinephrine-refractory vasoplegia after cardiopulmonary bypass.
A total of 54 patients with norepinephrine-refractory vasoplegia after cardiopulmonary bypass were treated with methylene blue (2 mg/kg) administered intravenously through a period of 20 minutes. The effects on hemodynamics, norepinephrine dosage, and clinical outcome were evaluated.
Three patients (5.6%) died during the hospital stay. A clinically relevant increase in systemic vascular resistance and a decrease in norepinephrine dosage were observed in 51 patients within 1 hour after methylene blue infusion. Four patients (7.4%) had no response to methylene blue. No adverse effects related to methylene blue were observed.
A single dose of methylene blue seems to be a potent approach to norepinephrine-refractory vasoplegia after cardiopulmonary bypass for most patients, with no obvious side effects. Guanylate cyclase inhibitors could be a novel class of agents for the treatment of norepinephrine-refractory vasoplegia after cardiopulmonary bypass. A controlled clinical trial is now needed to evaluate the role of methylene blue in this situation.
血管麻痹是体外循环后常见的并发症，常需应用去甲肾上腺素。然而，在许多情况下，血管麻痹对去甲肾上腺素治疗无效。鸟苷酸环化酶抑制剂亚甲蓝可能是此类病例中一种有吸引力的治疗选择。本研究探讨亚甲蓝治疗体外循环后对去甲肾上腺素抵抗的血管麻痹的效果。
共有54例体外循环后出现去甲肾上腺素抵抗性血管麻痹的患者接受了亚甲蓝（2mg/kg）静脉注射，注射时间为20分钟。评估其对血流动力学、去甲肾上腺素剂量及临床结局的影响。
3例患者（5.6%）在住院期间死亡。51例患者在输注亚甲蓝后1小时内出现全身血管阻力显著增加及去甲肾上腺素剂量减少。4例患者（7.4%）对亚甲蓝无反应。未观察到与亚甲蓝相关的不良反应。
对于大多数患者，单次剂量的亚甲蓝似乎是治疗体外循环后去甲肾上腺素抵抗性血管麻痹的有效方法，且无明显副作用。鸟苷酸环化酶抑制剂可能是治疗体外循环后去甲肾上腺素抵抗性血管麻痹的一类新型药物。目前需要进行一项对照临床试验来评估亚甲蓝在此类情况下的作用。
