亚甲蓝在脓毒症和脓毒性休克中的应用：一项系统评价和荟萃分析。
Methylene blue in sepsis and septic shock: a systematic review and meta-analysis.
作者信息
Ballarin Raquel Simões, Lazzarin Taline, Zornoff Leonardo, Azevedo Paula Schmidt, Pereira Filipe Welson Leal, Tanni Suzana Erico, Minicucci Marcos Ferreira
机构信息
Internal Medicine Department, Medical School, São Paulo State University (UNESP), Botucatu, Brazil.
出版信息
Front Med (Lausanne). 2024 Apr 18;11:1366062. doi: 10.3389/fmed.2024.1366062. eCollection 2024.
BACKGROUND
Methylene blue is an interesting approach in reducing fluid overload and vasoactive drug administration in vasodilatory shock. The inhibition of guanylate cyclase induced by methylene blue infusion reduces nitric oxide production and improves vasoconstriction. This systematic review and meta-analysis aimed to assess the effects of methylene blue administration compared to placebo on the hemodynamic status and clinical outcomes in patients with sepsis and septic shock.
METHODS
The authors specifically included randomized controlled trials that compared the use of methylene blue with placebo in adult patients with sepsis and septic shock. The outcomes were length of intensive care unit stay, hemodynamic parameters [vasopressor use], and days on mechanical ventilation. We also evaluated the abnormal levels of methemoglobinemia. This systematic review and meta-analysis were recorded in PROSPERO with the ID CRD42023423470.
RESULTS
During the initial search, a total of 1,014 records were identified, out of which 393 were duplicates. Fourteen citations were selected for detailed reading, and three were selected for inclusion. The studies enrolled 141 patients, with 70 of them in the methylene blue group and 71 of them in the control group. Methylene blue treatment was associated with a lower length of intensive care unit stay (MD -1.58; 95%CI -2.97, -0.20; = 25%; = 0.03), decreased days on mechanical ventilation (MD -0.72; 95%CI -1.26, -0.17; = 0%; = 0.010), and a shorter time to vasopressor discontinuation (MD -31.49; 95%CI -46.02, -16.96; = 0%; < 0.0001). No association was found with methemoglobinemia.
CONCLUSION
Administering methylene blue to patients with sepsis and septic shock leads to reduced time to vasopressor discontinuation, length of intensive care unit stay, and days on mechanical ventilation.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023423470, CRD42023423470.
背景
亚甲蓝是一种减少血管扩张性休克患者液体超负荷和血管活性药物使用的有趣方法。亚甲蓝输注诱导的鸟苷酸环化酶抑制可减少一氧化氮生成并改善血管收缩。本系统评价和荟萃分析旨在评估与安慰剂相比，亚甲蓝给药对脓毒症和脓毒性休克患者血流动力学状态和临床结局的影响。
方法
作者特别纳入了比较亚甲蓝与安慰剂在成年脓毒症和脓毒性休克患者中使用情况的随机对照试验。结局指标为重症监护病房住院时间、血流动力学参数[血管升压药使用情况]和机械通气天数。我们还评估了高铁血红蛋白血症的异常水平。本系统评价和荟萃分析已在国际前瞻性系统评价注册库（PROSPERO）中注册，注册号为CRD42023423470。
结果
在初步检索中，共识别出1014条记录，其中393条为重复记录。筛选出14篇文献进行详细阅读，最终纳入3篇。这些研究共纳入141例患者，其中亚甲蓝组70例，对照组71例。亚甲蓝治疗与缩短重症监护病房住院时间（MD -1.58；95%CI -2.97，-0.20；I² = 25%；P = 0.03）、减少机械通气天数（MD -0.72；95%CI -1.26，-0.17；I² = 0%；P = 0.010）以及缩短停用血管升压药时间（MD -31.49；95%CI -46.02，-16.96；I² = 0%；P < 0.0001）相关。未发现与高铁血红蛋白血症有关联。
结论
对脓毒症和脓毒性休克患者使用亚甲蓝可缩短停用血管升压药时间、重症监护病房住院时间和机械通气天数。
系统评价注册信息
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023423470，CRD42023423470
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