Lutjen Dina L, Arndt Karri L
University of Kansas Medical Center, Kansas City, USA.
AANA J. 2012 Jun;80(3):170-3.
Protamine sulfate is used during coronary artery bypass graft surgery to reverse the anticoagulating effects of heparin. Vasoplegic syndrome is a state of endothelial dysregulation that produces profound vasodilatation that is refractory to vasopressors. This syndrome leads to systemic hypoperfusion and may progress to death. Up to 27% of patients after cardiac bypass may experience vasoplegia. Symptoms of vasoplegia may also be present in many different clinical settings. This case report describes a 57-year-old woman who after cardiac bypass experienced a severe protamine reaction with profound hypotension, which was unresponsive to volume resuscitation and vasopressor therapy. A dramatic increase in blood pressure resulted almost immediately after administration of methylene blue. This patient had no prior risk factors for a protamine reaction other than her current cardiac surgery. A review of the pathophysiologic characteristics associated with vasoplegia and the pharmacodynamics of methylene blue will potentially enable anesthesia providers to utilize this lifesaving drug when needed.
硫酸鱼精蛋白在冠状动脉搭桥手术中用于逆转肝素的抗凝作用。血管麻痹综合征是一种内皮功能失调状态，可导致严重的血管扩张，对血管升压药无效。该综合征会导致全身灌注不足，并可能进展至死亡。心脏搭桥术后高达27%的患者可能会出现血管麻痹。血管麻痹症状也可能出现在许多不同的临床情况中。本病例报告描述了一名57岁女性，在心脏搭桥术后发生严重的鱼精蛋白反应，伴有严重低血压，对容量复苏和血管升压药治疗无反应。静脉注射亚甲蓝后几乎立即出现血压急剧升高。除了当前的心脏手术外，该患者既往没有鱼精蛋白反应的危险因素。回顾与血管麻痹相关的病理生理特征和亚甲蓝的药效学，可能会使麻醉医生在需要时能够使用这种救命药物。
