CC:亚甲基蓝在感染性休克中的应用:利弊

Septic shock typically requires the administration of vasopressors. Adrenergic agents remain the first choice, namely norepinephrine. However, their use to counteract life‐threatening hypotension comes with potential adverse effects, so that non‐adrenergic vasopressors may also be considered. The use of agents that act through different mecha‐ nisms may also provide an advantage. Nitric oxide (NO) is the main driver of the vasodilation that leads to hypoten‐ sion in septic shock, so several agents have been tested to counteract its effects. The use of non‐selective NO synthase inhibitors has been of questionable benefit. Methylene blue, an inhibitor of soluble guanylate cyclase, an important enzyme involved in the NO signaling pathway in the vascular smooth muscle cell, has also been proposed. However, more than 25 years since the first clinical evaluation of MB administration in septic shock, the safety and benefits of its use are still not fully established, and it should not be used routinely in clinical practice until further evidence of its efficacy is available.

感染性休克通常需要使用血管加压药。肾上腺素能药物仍是首选，即去甲肾上腺素。然而，使用它们来抵消危及生命的低血压会产生潜在的不良反应，因此也可以考虑使用非肾上腺素能血管加压药。使用通过不同机制起作用的药物也可能提供优势。一氧化氮(Nitric oxide, NO)是血管舒张的主要驱动因素，导致感染性休克时的低血压，因此已经有多种药物被测试来抵消其作用。使用非选择性NO合酶抑制剂的益处值得怀疑。可溶性鸟苷酸环化酶是参与血管平滑肌细胞NO信号通路的重要酶，亚甲蓝是可溶性鸟苷酸环化酶的抑制剂。然而，自首次对MB在感染性休克中的应用进行临床评估以来，已经超过25年，其使用的安全性和益处仍未完全确定，在获得进一步的疗效证据之前，不应常规应用于临床实践。