亚甲蓝对感染性休克患者术中氧代谢的影响  

Effect of methylene blue on oxygen metabolism in patients with septic shock

作　　者：熊响清[1] 金立达[1] 王良荣[1] 朱天琦[1] 彭宇[1] 林丽娜[1] 

机构地区：[1]温州医学院附属第一医院麻醉科,325000

出　　处：《中华麻醉学杂志》2010年第10期1239-1242,共4页Chinese Journal of Anesthesiology

摘　　要：目的 探讨亚甲蓝对感染性休克患者术中氧代谢的影响.方法 行急诊手术的感染性休克患者40例,ASA分级Ⅱ或Ⅲ级,年龄38～64岁,体重48～75 kg,随机分为2组（n=20）：去甲肾上腺素组（NE组）和亚甲蓝组（MB组）.人室后NE组静脉输注去甲肾上腺素0.5～2.0μg·kg-1·min-1至术毕,MB组静脉输注亚甲蓝0.5～1.0 mg·kg-1·h-1至术毕.静脉注射咪达唑仑-依托咪酯-舒芬太尼-维库溴铵麻醉诱导,经口气管插管行机械通气,术中吸入七氟醚,间断静脉注射维库溴铵和舒芬太尼维持麻醉.于麻醉诱导前（T0）、手术开始前（T1）、手术开始后30 min（T2）、60 min（T3）、90 min（T4）及术毕时（T5）记录HR、SvO2、MAP、CVP、每搏量,计算外周血管阻力指数（SVRI）、CI.于上述时点采集桡动脉和颈内静脉血样行血气分析,并测定动脉血乳酸（Lac）浓度,计算氧供指数（DO2I）、氧耗指数（VO2I）和氧摄取率（ERO2）.结果 与NE组比较,MB组MAP、HR、CVP、SVRI、DO2I、VO2I和ERO2升高,CI和Lac降低（P＜0.05）.与T0时比较,T2～5时MB组MAP、HR、CVP、SVRI、VO2I、DO2I和ERO2升高,CI和Lac降低,NE组CI和Lac降低,SVRI、VO2I和ERO2升高（P＜0.05）,DO2I差异无统计学意义（P＞0.05）.结论术中应用0.5～1.0 mg·kg-1·h-1亚甲蓝不仅可改善感染性休克患者术中血液动力学,还可改善机体氧代谢.Objective To investigate the effect of methylene blue （MB） on oxygen metabolism in patients with septic shock. Methods Forty ASA Ⅱ or Ⅲ patients with septic shock aged 38-64 yr weighing 48-75 kg undergoing emergency surgery were randomly divided into 2 groups （ n = 20 each）： group Ⅰ norepinephrine （group NE） and group Ⅱ MB. The patients were unpremedicated. Anesthesia was induced with midazolam, etomidate,sufentanil and vecuronium and maintained with inhalation of 0.5%-1.5% sevoflurane and intermittent iv boluses of sufentanil and vecuronium. The patients were mechanically ventilated after tracheal intubation. PETCO2 was maintained at 35-45 mm Hg. During operation MB was infused at 0.5-1.0 mg·kg-1·h-1 in group MB and NE at 0.5-2.0 μg· kg-1 · min-1 in group NE respectively to maintain hemodynamic stability. Radial artery was cannulated and connected with Vigileo cardiac output monitor. Right internal jugular vein was cannulated for CVP monitoring.HR, SvO2, MAP, CVP, SV and CI were continuously monitored. Arterial and central venous blood samples were collected simultaneously before induction of anesthesia （T0, baseline）, immediately before （T1） and at 30, 60 and 90 min after skin incision （T2-4） and at the end of operation （T5） . Blood gas analysis was performed. O2 consumption index （VO2I）, O2 delivery index （DO2I） and O2 extraction rate （ERO2） were calculated. Blood lactate concentration was measured. Results MAP, HR, CVP, SVRI, DO2I, VO2I and ERO2 were significantly higher,while CI and blood lactate concentration lower during operation （T2-5） in group MB than in group NE. MAP, HR,CVP, SVRI, VO2I, DO2I, and ERO2 were significantly higher, while CI and blood lactate concentration were lower during operation （T2-5） as compared with the baseline values at T0 in group MB. In group NE there were no significant change in MAP, HR, CVP and DO2I during operation （T2-5 ） as compared with the baseline at T0. Conclusion Intravenous infusion of MB at 0.5-1.0

关 键 词：亚甲蓝 休克 脓毒性 氧耗量 

分 类 号：R614[医药卫生—麻醉学]