亚甲蓝持续延长输注治疗难治性感染性休克
Extended Continuous Infusion of Methylene Blue for Refractory Septic Shock.
作者信息
Jaiswal Abhishek, Kumar Manish, Silver Elizabeth
机构信息
Department of Cardiology, Hartford Hospital Heart and Vascular Institute, Hartford, Connecticut, USA.
出版信息
Indian J Crit Care Med. 2020 Mar;24(3):206-207. doi: 10.5005/jp-journals-10071-23376.
OBJECTIVE
Highlight the utility of methylene blue (MTB) infusion for extended period for refractory vasoplegia.
INTRODUCTION
Hypotension refractory to vasopressor therapy in sepsis is associated with high mortality and limited therapeutic options. Dysregulated nitric oxide (NO) pathway seems to be a major driver, and, therefore, MTB, which inhibits inducible NO synthase activity and decreases cyclic guanosine monophosphate (GMP) accumulation by directly competing with NO by binding to soluble guanylyl cyclase, has been explored.
CASE DESCRIPTION
We describe a successful reversal of refractory septic shock with prolonged MTB infusion in a patient supported on multiple vasopressors at the highest clinical doses as well as venovenous extracorporeal membrane oxygenation (VV-ECMO).
CONCLUSION AND CLINICAL SIGNIFICANCE
Current report suggests a potential role of MTB infusion in refractory vasoplegia even in advanced vasoplegic shock.
HOW TO CITE THIS ARTICLE
Jaiswal A, Kumar M, Silver E. Extended Continuous Infusion of Methylene Blue for Refractory Septic Shock. Indian J Crit Care Med 2020;24(3):206-207.
目的
强调长时间输注亚甲蓝（MTB）治疗难治性血管麻痹的效用。
引言
脓毒症中对血管升压药治疗无效的低血压与高死亡率及有限的治疗选择相关。一氧化氮（NO）通路失调似乎是主要驱动因素，因此，已对MTB进行了研究，MTB通过与可溶性鸟苷酸环化酶结合直接与NO竞争，从而抑制诱导型NO合酶活性并减少环磷酸鸟苷（GMP）积累。
病例描述
我们描述了一名患者，在接受最高临床剂量的多种血管升压药以及静脉-静脉体外膜肺氧合（VV-ECMO）支持的情况下，通过长时间输注MTB成功逆转了难治性感染性休克。
结论及临床意义
当前报告表明，即使在晚期血管麻痹性休克中，MTB输注在难治性血管麻痹中也具有潜在作用。
如何引用本文
Jaiswal A, Kumar M, Silver E. Extended Continuous Infusion of Methylene Blue for Refractory Septic Shock. Indian J Crit Care Med 2020;24(3):206-207.
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