Gerdes Harrison J, Seelhammer Troy G, Nei Scott, Diaz Soto Juan, Nabzdyk Christoph G
Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, USA.
Pharmacy, Mayo Clinic, Rochester, USA.
Cureus. 2021 Feb 17;13(2):e13388. doi: 10.7759/cureus.13388.
Nitric oxide (NO) is a gaseous signaling molecule and a key endogenous mediator of vascular tone. Hydroxocobalamin (HCB) affects NO-mediated vasoplegia as (1) a direct inhibitor of nitric oxide synthase (NOS), thereby decreasing its production, and (2) by binding directly to NO and acting as a scavenger. HCB has been increasingly used in the treatment of refractory vasoplegia, particularly in cardiac surgery and liver transplant patients. Sepsis and septic shock are characterized by an increase in inducible NOS expression and activity with excessive NO production, resulting in endothelial dysfunction and profound systemic vasodilation. Therefore, a careful sustained reduction in NO burden represents a potential therapeutic target. Here, we present a case of refractory septic shock, which resolved after an extended duration infusion of high-dose HCB. We hope to foster further exploration regarding the safety, dosing, and efficacy of HCB when administered for vasopressor refractory septic shock.
一氧化氮（NO）是一种气体信号分子，也是血管张力的关键内源性介质。羟钴胺（HCB）通过以下方式影响NO介导的血管麻痹：（1）作为一氧化氮合酶（NOS）的直接抑制剂，从而减少其生成；（2）直接与NO结合并作为清除剂。HCB越来越多地用于治疗难治性血管麻痹，尤其是在心脏手术和肝移植患者中。脓毒症和脓毒性休克的特征是诱导型NOS表达和活性增加，NO产生过多，导致内皮功能障碍和严重的全身血管舒张。因此，谨慎持续降低NO负荷是一个潜在的治疗靶点。在此，我们报告一例难治性脓毒性休克病例，该病例在长时间输注高剂量HCB后得到缓解。我们希望促进对HCB用于血管升压药难治性脓毒性休克时的安全性、剂量和疗效进行进一步探索。
