Deparment of Pediatrics, National Hospital Edgardo Rebagliati Martins, Lima, Peru.
Deparment of Critical Care, Instituto Nacional De Salud Del Niño Breña, Lima, Peru.
BMJ Case Rep. 2022 Feb 28;15(2):e243772. doi: 10.1136/bcr-2021-243772.
Current therapies frequently used for refractory septic shock include hydrocortisone, vasopressin, extracorporeal membrane oxygenation (ECMO) support, inodilators, levosimendan and methylene blue. The evidence for these treatments is very limited. We present a case of a 5-year-old patient with refractory septic shock, secondary to meningitis. She presented with status epilepticus and developed septic shock. Shock persisted despite multiple high-dose vasoactive medications. ECMO support was not available. The medical team decided to use methylene blue to revert the vasoplegia, with excellent results. Shortly after the administration, vasopressors were weaned off and the high lactate cleared. She developed severe neurological sequelae due to brain haemorrhage secondary to the meningitis. The evidence supporting methylene blue for refractory septic shock in paediatric patients is limited. This case represents the effectiveness of this therapy without secondary effects.
目前常用于难治性感染性休克的治疗方法包括氢化可的松、血管加压素、体外膜肺氧合（ECMO）支持、正性肌力药、左西孟旦和亚甲蓝。这些治疗方法的证据非常有限。我们报告了一例 5 岁患者，因脑膜炎继发难治性感染性休克，患者出现癫痫持续状态并发生感染性休克。尽管使用了多种大剂量血管活性药物，但休克仍持续存在。无法提供 ECMO 支持。医疗团队决定使用亚甲蓝逆转血管麻痹，效果非常好。在给药后不久，血管加压剂逐渐停用，高乳酸血症得到清除。由于脑膜炎继发的脑出血，她出现严重的神经后遗症。支持亚甲蓝治疗儿童难治性感染性休克的证据有限。本病例代表了该疗法的有效性，没有副作用。
