亚甲蓝治疗药物性血管扩张性休克后血流动力学的改善：一例报告
Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report.
作者信息
Laes JoAn R, Williams David M, Cole Jon B
机构信息
Minnesota Poison Control System, Hennepin County Medical Center, 701 Park Avenue, Mail Code RL, Minneapolis, MN, 55415, USA.
Hennepin County Medical Center Critical Care Fellowship, Hennepin County Medical Center, Minneapolis, MN, USA.
出版信息
J Med Toxicol. 2015 Dec;11(4):460-3. doi: 10.1007/s13181-015-0500-1.
INTRODUCTION
The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient.
CASE REPORT
This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg.
DISCUSSION
Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.
引言
本研究的目的是描述一例亚甲蓝改善中毒患者血流动力学的病例。
病例报告
这是一份单病例报告，一名中毒患者在摄入阿替洛尔、氨氯地平和缬沙坦后发生血管舒张性休克。在接受包括血管加压药、高剂量胰岛素、血液透析和20%静脉脂肪乳剂在内的多种治疗后，休克仍持续存在。在重症监护病房给予亚甲蓝（2mg/kg静脉注射，持续30分钟），根据肺动脉导管血流动力学数据在亚甲蓝给药前后的测量结果，显示出暂时的改善。在给予亚甲蓝后1小时内，全身血管阻力改善（从240达因秒/厘米⁵增加到1204达因秒/厘米⁵），血管加压药需求减少，平均动脉压维持在60mmHg。
讨论
亚甲蓝可能改善药物性血管舒张性休克的血流动力学，对于因血管舒张性药物中毒且对标准治疗无效的危重症患者应考虑使用。
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