Gachot B, Bedos J P, Veber B, Wolff M, Regnier B
Clinique de Reanimation des Maladies Infectieuses, Hopital Bichat-Claude Bernard, Paris, France.
Intensive Care Med. 1995 Dec;21(12):1027-31. doi: 10.1007/BF01700666.
The aim of this study was to investigate the acute effects of methylene blue (MB), an inhibitor of the L-arginine nitric oxide pathway, in patients with septic shock.
A prospective, open, single-dose study.
The medical ICU of a university hospital.
Six patients with severe septic shock.
Complete hemodynamic values were recorded before and 20 min after the infusion of intravenous MB (3 mg kg(-1)). Arterial pressure was then monitored during the next 24 h or until death.
Methylene blue increased the mean arterial pressure from 69.7 +/- 4.5 to 83.7 +/- 5.1 mmHg (p = 0.028) and the mean pulmonary artery pressure, from 34.3 +/- 7.2 to 38.7 +/- 8.0 mmHg (p = 0.023). Systemic vascular resistance index was increased from 703.1 +/- 120.6 to 903.7 +/- 152.2 dyne.s.cm(-5).m(-2) (p = 0.028) and pulmonary vascular resistance index, from 254.6 +/- 96.9 to 342.2 +/- 118.9 dyne.s.cm(-5) .m(-2) (p = 0.027). The PaO2/FIO2 decreased from 229.2 +/- 54.4 to 162.2 +/- 44.1 mmHg (p = 0.028), without significant modification of intrapulmonary shunting. Heart rate, cardiac index, right atrial pressure, DO2, VO2, oxygen extraction and arterial lactate were essentially unchanged. Sequential measurements of arterial pressure demonstrated a return to baseline level in 2-3 h. All but one patients died, three in shock and two in multiple organ failure.
MB induces systemic and pulmonary vasoconstriction in patients with septic shock, without significant decrease in cardiac index. The worsening of arterial oxygenation following MB injection may limit its use in patients with the adult respiratory distress syndrome. Larger studies are required to determine whether MB improves the outcome of patients with septic shock.
本研究旨在调查L-精氨酸一氧化氮途径抑制剂亚甲蓝（MB）对感染性休克患者的急性影响。
一项前瞻性、开放性、单剂量研究。
一所大学医院的医学重症监护病房。
6例严重感染性休克患者。
在静脉输注MB（3mg/kg(-1)）前及输注后20分钟记录完整的血流动力学值。随后在接下来的24小时内或直至死亡期间监测动脉压。
亚甲蓝使平均动脉压从69.7±4.5mmHg升至83.7±5.1mmHg（p=0.028），平均肺动脉压从34.3±7.2mmHg升至38.7±8.0mmHg（p=0.023）。全身血管阻力指数从703.1±120.6增至903.7±152.2达因·秒·厘米(-5)·米(-2)（p=0.028），肺血管阻力指数从254.6±96.9增至342.2±118.9达因·秒·厘米(-5)·米(-2)（p=0.027）。动脉血氧分压/吸入氧分数比值从229.2±54.4降至162.2±44.1mmHg（p=0.028），肺内分流无显著改变。心率、心脏指数、右心房压、氧输送、氧消耗、氧摄取及动脉血乳酸基本未变。动脉压的连续测量显示在2 - 3小时内恢复至基线水平。除1例患者外所有患者均死亡，3例死于休克，2例死于多器官功能衰竭。
MB可引起感染性休克患者全身和肺血管收缩，而心脏指数无显著降低。MB注射后动脉氧合恶化可能限制其在成人呼吸窘迫综合征患者中的应用。需要进行更大规模的研究以确定MB是否能改善感染性休克患者的预后。
