基于梅奥诊所28478例经食管超声心动图检查的经验：苯佐卡因诱导的高铁血红蛋白血症的发病率、结局及易感因素

Benzocaine-induced methemoglobinemia based on the Mayo Clinic experience from 28 478 transesophageal echocardiograms: incidence, outcomes, and predisposing factors.

作者信息

Kane Garvan C, Hoehn Suzette M, Behrenbeck Thomas R, Mulvagh Sharon L

机构信息

Echocardiography Laboratory, Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

出版信息

Arch Intern Med. 2007 Oct 8;167(18):1977-82. doi: 10.1001/archinte.167.18.1977.

DOI:10.1001/archinte.167.18.1977

PMID:17923598

Abstract

BACKGROUND

The potentially life-threatening condition of methemoglobinemia is characterized by cyanosis, low pulse oximetric readings, and normal arterial Po(2) values. Acquired methemoglobinemia has been linked to the use of the topical anesthetic benzocaine in endoscopic procedures, including transesophageal echocardiography (TEE). Yet, the incidence of benzocaine-induced methemoglobinemia with TEE and the clinical factors associated with its development are unclear.

METHODS

All cases of methemoglobinemia complicating TEE at our institution (from January 1, 1999, to July 1, 2006) were identified by a comprehensive review of medical records and echocardiography and pharmacy databases.

RESULTS

During 90 months among 28 478 TEEs, 19 cases of methemoglobinemia were identified, with a mean +/- SD methemoglobin level of 32% +/- 15%. All patients were cyanotic, with low oxygen saturations. Eighteen of 19 patients received methylene blue (mean +/- SD dose, 1.3 +/- 0.4 mg/kg of body weight), with resolution of symptoms and signs. One of 19 cases resolved spontaneously. Compared with a random sample of 190 patients undergoing TEE, the age, sex, body mass index, left ventricular systolic function, and dose of sedation (midazolam hydrochloride, fentanyl citrate, or both) were similar in the 2 groups. However, study patients who developed methemoglobinemia were more likely to be hospitalized (89.5% vs 57.6%, P =.005), be anemic (84.2% vs 44.7%, P =.002), and have active systemic infection (68.4% vs 6.8%; P < .001) at the time of TEE compared with the random control cohort.

CONCLUSIONS

In a large series of patients undergoing TEE, the incidence of methemoglobinemia is low (1 case per 1499 [0.067%; 95% confidence interval, 0.040%-0.100%]) and has a good outcome if promptly recognized and treated. Clinical factors associated with the development of methemoglobinemia include sepsis, anemia, and hospitalization. Minimizing or avoiding the use of benzocaine in these patients is recommended.

摘要

背景

高铁血红蛋白血症这种潜在的危及生命的病症表现为发绀、脉搏血氧饱和度读数低以及动脉血氧分压值正常。获得性高铁血红蛋白血症与在内镜检查程序（包括经食管超声心动图[TEE]）中使用局部麻醉药苯佐卡因有关。然而，TEE引发的苯佐卡因所致高铁血红蛋白血症的发生率及其发生的相关临床因素尚不清楚。

方法

通过全面查阅病历以及超声心动图和药房数据库，确定了我院（从1999年1月1日至2006年7月1日）所有并发TEE的高铁血红蛋白血症病例。

结果

在28478例TEE检查的90个月期间，共确定了19例高铁血红蛋白血症病例，高铁血红蛋白水平的平均值±标准差为32%±15%。所有患者均有发绀，血氧饱和度低。19例患者中有18例接受了亚甲蓝治疗（平均±标准差剂量，1.3±0.4mg/kg体重），症状和体征得以缓解。19例中有1例自行缓解。与190例接受TEE检查的随机样本患者相比，两组患者的年龄、性别、体重指数、左心室收缩功能以及镇静剂（盐酸咪达唑仑、枸橼酸芬太尼或两者）剂量相似。然而，与随机对照队列相比，发生高铁血红蛋白血症的研究患者在进行TEE检查时更有可能住院（89.5%对57.6%，P = 0.005）、贫血（84.2%对44.7%，P = 0.002）以及患有活动性全身感染（68.4%对6.8%；P < 0.001）。