Arevalo Vanessa N, Bullerwell Megan L
received her DNP from Baylor College of Medicine in December 2016. She is an instructor of anesthesiology at Baylor College of Medicine and works at Texas Children's Hospital, both in Houston, Texas.
received her doctoral degree from Baylor College of Medicine in 2013. She is an assistant professor of anesthesiology and allied health sciences and associate director of the Doctor of Nursing Practice-Nurse Anesthesia Program at Baylor College of Medicine. Dr Bullerwell has clinical responsibilities at Ben Taub Hospital in Houston, Texas.
AANA J. 2018 Dec;86(6):455-463.
The term vasoplegia describes hypotension refractory to vasopressor therapy, a common finding related to cardiac surgery requiring cardiopulmonary bypass. High doses of vasoactive agents are associated with adverse effects such as peripheral and mesenteric ischemia. Databases were systematically searched for literature on methylene blue as an adjunct therapy to treat vasoplegia. Fifteen articles were selected. The quality of the studies was evaluated using the US Preventive Services Task Force (USPSTF) grading tool, and a chart was created to present the components of each study. Preoperative, intraoperative, and postoperative administration of methylene blue has been shown to increase systemic vascular resistance and mean arterial pressure, with the period after surgery being the most common time for use of this therapy. Decreased vasopressor requirements have also been consistently demonstrated after methylene blue administration. This catecholamine-sparing effect prevents vasopressor-related injury. Its favorable safety profile as well as hemodynamic effects have made methylene blue a valuable adjunct in the setting of vasoplegia. Methylene blue is an effective treatment of refractory hypotension related to cardiac surgery requiring cardiopulmonary bypass. Larger, randomized controlled trials are needed to strengthen the state of the evidence and to define specific doses.
血管麻痹一词描述的是对血管升压药治疗无效的低血压，这是与需要体外循环的心脏手术相关的常见现象。高剂量的血管活性药物会带来如外周和肠系膜缺血等不良反应。我们系统检索了数据库中有关亚甲蓝作为治疗血管麻痹辅助疗法的文献。共筛选出15篇文章。使用美国预防服务工作组（USPSTF）分级工具对研究质量进行评估，并创建图表展示每项研究的组成部分。术前、术中和术后给予亚甲蓝已被证明可增加体循环血管阻力和平均动脉压，术后阶段是使用该疗法最常见的时间。给予亚甲蓝后，血管升压药的需求量也持续减少。这种儿茶酚胺节省效应可防止与血管升压药相关的损伤。其良好的安全性和血流动力学效应使亚甲蓝成为血管麻痹情况下有价值的辅助药物。亚甲蓝是治疗与需要体外循环的心脏手术相关的难治性低血压的有效方法。需要开展更大规模的随机对照试验来强化证据状况并确定具体剂量。
