感染性休克
医学
一氧化氮
败血症
病理生理学
休克(循环)
亚甲蓝
环磷酸鸟苷
血管舒张
药理学
调解人
变向性
麻醉
重症监护医学
内科学
生物化学
化学
催化作用
光催化
作者
Biplab K. Saha,Stacey Burns
标识
DOI:10.1016/j.amjms.2020.06.007
摘要
Methylene blue (MB) is considered to be the first synthetic medication ever used in humans. There are many indications for MB, including vasoplegic shock. Nitric oxide (NO), the central mediator of sepsis, promotes vasoplegia by enhancing the guanylate cyclase cyclic guanosine monophosphate second messenger system, the effect of which is attenuated by MB. Therefore, the use of MB represents a unique pharmacologic approach towards treating the underlying pathophysiology of vasoplegia in sepsis. There are numerous reports of the successful use of MB in refractory shock in the literature. This manuscript describes the historical aspects of the identification of NO as the endothelial derived relaxation factor and its role in the pathogenesis of vasoplegia in septic shock. An analysis of the existing evidence for the use of MB as an inhibitor of NO in vasodilatory shock is provided. The adverse effects associated with the use of MB and an approach to optimal dosing in septic shock are also addressed.
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