亚甲蓝治疗脓毒症休克的研究进展

doi:10.3877/cma.j.issn.2096-1537.2024.02.008

脓毒症休克危及生命，去甲肾上腺素为脓毒症休克治疗的一线血管活性药物，大剂量应用和病死率增加相关。2016年拯救脓毒症运动（SSC）指南建议必要时联合其他药物以降低其剂量，2021年SSC指南进一步建议应早期联合血管升压素等。亚甲蓝能增加平均动脉压（MAP）和全身血管阻力（SVR），减少儿茶酚胺类血管活性药物的剂量，可以降低病死率，缩短ICU时间和住院时间。亚甲蓝国内价格低廉，无严重不良反应，可能是临床的一个重要选择，但需要高水平研究进一步确定并提高其在联合用药中的地位。本文在现有文献报告的基础上，总结亚甲蓝治疗脓毒症休克的时机、剂量、给药方式，以期为临床治疗提供参考。

关键词: 脓毒症休克, 亚甲蓝, 去甲肾上腺素, 一氧化氮, 一氧化氮合酶

Septic shock is life-threatening, and noradrenaline is a first-line vasoactive drug for its treatment.High-dose administration of noradrenaline is associated with increased mortality. According to the 2016 Surviving Sepsis Campaign (SSC) guidelines, it is recommended to combine with other drugs to reduce its dosage when necessary.The 2021 SSC guidelines further suggest early administration in combination with other vasopressors instead of escalating the dose of norepinephrine. Methylene blue (MB) can increase mean arterial pressure (MAP) and systemic vascular resistance (SVR) and reduce the dosage of catecholamine vasoactive drugs, thereby reducing mortality rates and shortening ICU and hospital stays. MB is cost-effective domestically with no severe adverse reactions, making it a potential clinical option. However, further high-level research is required to confirm its role and enhance its position in combined medication. This article, based on existing literature reports, summarizes the timing, dosage, and administration methods of methylene blue in the treatment of sepsis shock, aiming to provide a reference for clinical treatment.

Key words: Septic shock, Methylene blue, Norepinephrine, Nitric oxide, Nitric oxide synthase

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