METHYLENE-BLUE INCREASES MYOCARDIAL-FUNCTION IN SEPTIC SHOCK
METHYLENE-BLUE INCREASES MYOCARDIAL-FUNCTION IN SEPTIC SHOCK
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DOI：
10.1097/00003246-199508000-00009
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发表时间：
1995-08-01
影响因子：
8.8
通讯作者：
THIJS, LG
中科院分区：
文献类型：
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作者：
DAEMENGUBBELS, CRGH;GROENEVELD, PHP;THIJS, LG
目的：研究感染性休克的循环系统变化是否部分由一氧化氮介导。设计：一项关于一氧化氮抑制剂亚甲蓝作用的开放标签、非随机临床试验。设置：一所教学医院的重症监护室。患者：9名连续的患者记录了感染性休克和肺动脉导管，在用液体、拟交感神经药进行初步复苏后，和机械通气，干预：在开始20分钟输注2 mg/kg亚甲蓝之前和之后15、30、60和120分钟测量血液动力学和代谢变量。患者的循环动力过高，而亚甲蓝增加（p <0.01）平均动脉压从84 +/- 18至109 +/- 31 mm Hg，心脏指数从4.7 +/- 0.9至5.6 +/- 1.2 L/min/ m（2），分别在开始亚甲蓝输注之前和开始亚甲蓝输注之后30分钟。心脏充盈压没有变化。在相同的时间间隔内，低于正常的全身血管阻力指数增加（p = 0.09），动脉顺应性降低（p <0.05）。氧输送和氧摄取增加（p < .05）分别从714 +/- 188至865 +/- 250 mL/min/m2和从160 +/- 39至186 +/- 44 mL/min/m2，心率除外，心率增加了11 +/- 8次/min（p <0.01），变量在时间= 120 minutes.Conclusions恢复到基线值后，从人类感染性休克的初始复苏，一个单一剂量的亚甲蓝短暂增加平均动脉压和氧摄取，与动脉顺应性下降，心肌功能和氧输送增加。因此，一氧化氮可能是人类感染性休克循环变化的介质。
Objective: To study whether the circulatory changes of human septic shock are mediated in part by nitric oxide.Design: Open-label, nonrandomized clinical trial on the effects of methylene blue, an inhibitor of nitric oxide action.Setting: Intensive care unit of a teaching hospital.Patients: Nine consecutive patients with documented septic shock and a pulmonary artery catheter in place, after initial resuscitation with fluids, sympathomimetics, and mechanical ventilation, Interventions: Hemodynamic and metabolic variables were measured before and then 15, 30, 60, and 120 mins after the start of a 20-min infusion of 2 mg/kg of methylene blue.Measurements and Main Results: Patients had a hyperdynamic circulation, and methylene blue increased (p < .01) mean arterial pressure from 84 +/- 18 to 109 +/- 31 mm Hg and cardiac index from 4.7 +/- 0.9 to 5.6 +/- 1.2 L/min/ m(2), before and 30 mins after starting the methylene blue infusion, respectively. Cardiac filling pressures did not change. In the same time interval, the subnormal systemic vascular resistance index increased (p = .09) and arterial compliance decreased (p < .05). Oxygen delivery and oxygen uptake increased (p < .05) from 714 +/- 188 to 865 +/- 250 mL/min/m(2) and from 160 +/- 39 to 186 +/- 44 mL/min/m(2), respectively, Except for heart rate, which increased by 11 +/- 8 beats/min (p < .01), variables returned to baseline values at time = 120 mins.Conclusions: After initial resuscitation from human septic shock, a single dose of methylene blue transiently increases mean arterial pressure and oxygen uptake, associated with a decrease in arterial compliance and increases in myocardial function and oxygen delivery. Hence, nitric oxide may be a mediator of the circulatory changes of human septic shock.