Patel C B, Laboy V, Venus B, Mathru M, Wier D
Chest. 1986 May;89(5):663-7. doi: 10.1378/chest.89.5.663.
In 292 patients who underwent coronary artery bypass graft (CABG) surgery, seven patients developed sodium nitroprusside (SNP) toxicity in the postoperative period. Duration of infusion varied between 26 to 160 hrs and total SNP dose ranged from 1.8 to 12 mg/kg body weight. All patients were critically ill and required ventilatory support in the postoperative period. Tachyphylaxis to SNP requiring increase of SNP dose for control of hypertension, and loss of consciousness were the major signs of toxicity. Other commonly described signs of SNP toxicity were absent in those patients. Discontinuation of SNP therapy and treatment with sodium thiosulfate was followed by improvement in four patients. Three patients who failed to regain consciousness later died because of hemodynamic, pulmonary and/or renal complications. Our observation suggests that recommended doses of SNP may be toxic in unstable post-CABG patients. We recommend that the dose and duration of SNP infusion be minimized in critically ill patients.
在292例行冠状动脉旁路移植术（CABG）的患者中，有7例在术后出现硝普钠（SNP）毒性。输注持续时间在26至160小时之间，SNP总剂量为1.8至12mg/kg体重。所有患者病情危重，术后均需要通气支持。对SNP产生快速耐受性，需要增加SNP剂量以控制高血压，以及意识丧失是毒性的主要表现。这些患者未出现其他常见的SNP毒性表现。4例患者在停用SNP治疗并用硫代硫酸钠治疗后病情好转。3例未能恢复意识的患者后来因血流动力学、肺部和/或肾脏并发症死亡。我们的观察表明，推荐剂量的SNP可能对CABG术后不稳定的患者有毒性。我们建议在危重症患者中尽量减少SNP输注的剂量和持续时间。
