McCartney Sharon L, Duce Lorent, Ghadimi Kamrouz
Divisions of Cardiothoracic Anesthesia and Critical Care Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
Division of Cardiothoracic Anesthesia, Department of Anesthesiology, University of Florida, Gainesville, Florida, USA.
Curr Opin Anaesthesiol. 2018 Feb;31(1):43-49. doi: 10.1097/ACO.0000000000000548.
To evaluate the efficacy, dosing, and safety of methylene blue (MTB) in perioperative vasoplegic syndrome (VS).
Vasoplegic syndrome is a state of persistent hypotension with elevated cardiac output, low filling pressures, and low systemic vascular resistance (SVR). It occurs in up to 25% of patients undergoing cardiac surgery with cardiopulmonary bypass, can last up to 72 h, and is associated with a high mortality rate. MTB has been found to increase SVR and decrease vasopressor requirements in vasoplegic syndrome by inhibiting nitric oxide synthase, thus limiting the generation of nitric oxide, while inhibiting activation of soluble guanylyl cyclase and preventing vasodilation. MTB has been used in postgraft reperfusion during liver transplantation and anaphylaxis in a limited number of cases. Additionally, this medication has been used in septic shock with promising results, but similar to the cardiac surgical population, the effects of MTB administration on clinical outcomes has yet to be elucidated.
MTB should be considered during vasoplegic syndrome in cardiac surgery with cardiopulmonary bypass and usage may be more effective in an early critical window, prior to end-organ hypoperfusion. Other perioperative scenarios of MTB use show promise, but additional studies are required to develop formative conclusions.
评估亚甲蓝（MTB）在围手术期血管麻痹综合征（VS）中的疗效、给药剂量及安全性。
血管麻痹综合征是一种伴有心输出量增加、充盈压降低及全身血管阻力（SVR）降低的持续性低血压状态。它发生于高达25%的接受体外循环心脏手术的患者中，可持续长达72小时，并与高死亡率相关。已发现MTB可通过抑制一氧化氮合酶来增加血管麻痹综合征患者的SVR并减少血管升压药的用量，从而限制一氧化氮的生成，同时抑制可溶性鸟苷酸环化酶的激活并防止血管舒张。MTB已在肝移植术后移植物再灌注及少数过敏反应病例中使用。此外，这种药物已用于感染性休克并取得有前景的结果，但与心脏手术患者群体类似，MTB给药对临床结局的影响尚未阐明。
在接受体外循环心脏手术的血管麻痹综合征患者中应考虑使用MTB，且在终末器官灌注不足之前的早期关键窗口期使用可能更有效。MTB在其他围手术期情况下的应用显示出前景，但需要更多研究以得出确切结论。
