| Objective(s):Sepsis is a clinical syndrome of physiological and organ dysfunction caused by the dysregulation of the inflammatory response to infection.It is difficult to treat and the mortality rate is very high.At present,there are many studies on sepsis,but its pathogenesis is not fully understood.At present,it is believed that in addition to hemodynamic disorders,overstimulated inflammatory response and cytokine storm formation are also one of the important factors leading to the death of patients with sepsis.A number of studies at home and abroad have shown that methylene blue not only inhibit the activation of inflammasomes and reduce the expression of cytokines such as IL-1β,IL-6 and TNF-α,but also increase peripheral circulatory resistance and mean arterial pressure in patients with sepsis by inhibiting the production of nitric oxide in blood vessels.It is suggested that methylene blue has the potential effect of reducing inflammation and improving microcirculation perfusion.At present,there are few clinical studies on the anti-inflammatory effect of methylene blue in sepsis.Therefore,this study explored the effect of methylene blue on inflammatory factors and lactate levels in sepsis,as well as the effect of methylene blue on the condition and prognosis of patients with sepsis,so as to provide scientific basis for the subsequent application of methylene blue in sepsis.Methods:According to the sepsis 3.0 criteria,a total of 47 patients with sepsis admitted to the Intensive Care Unit of the Affiliated Hospital of Kunming University of Science and Technology(the First People’s Hospital of Yunnan Province)from January 2022 to January 2023 were enrolled in this study,including 23 cases in the experimental group and 24 cases in the control group.After admission,the patients in the two groups were treated according to the Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.All patients were evaluated and examined within 30 minutes after entering ICU,and the relevant examination data were recorded.On the basis of standard treatment according to the guidelines,the patients in the experimental group were given methylene blue intervention 6 hours after the diagnosis of sepsis,and methylene blue 2 mg/kg was slowly injected intravenously over 15 minutes,followed by 0.5 mg/(kg·h)continuously pumped intravenously for 24 hours.The two groups were compared before and after methylene blue treatment,and between the control group and the experimental group:(1)Baseline data(age,gender,SOFA score,APACHE-II score);(2)Relevant indicators at the beginning of methylene blue infusion(T0)and 24 hours after methylene blue infusion(T1): The levels of inflammatory factors(PCT,CRP and cytokines IL-1β,IL-2,IL-4,IL-6,IL-8,IL-10,IL-12P70,IL-17,TNF-α,INF-γ),blood lactic acid,SOFA score,APACHE-II score;(3)Clinical prognosis: the length of ICU stay and 28-day follow-up survival of patients in the two groups.SPSS26.0 software was used to analyze the data.Enumeration data within the group were described by examples and constituent ratio,and chi-square test was used for comparison.Normal distribution measurement data were described by mean ± standard deviation.Paired sample t test was used to compare the data before and after treatment in the same group.Paired sample t test was used to compare the data before and after treatment within the group,and independent sample t test was used to compare the data between the groups.The indicators at T0 of the two groups were included in binary Logistic regression analysis to identify the independent risk factors for death in patients with sepsis within 28 days.Finally,the ROC curve was drawn to evaluate the predictive value of each index for the death of patients with sepsis within 28 days.p < 0.05 indicated that the difference was statistically significant.Results:1.Effect of methylene blue on inflammatory indexes and microcirculation perfusion indexes in patients with sepsis(1)The average levels of CRP,IL-6 and IL-8 at T1 were lower than those at T0,and the difference was statistically significant(p < 0.05),while the average levels of inflammatory factors in the control group at T1 were not significantly different from those at T0(p > 0.05).There was no significant difference in the average levels of inflammatory factors between the experimental group and the control group at T0(p > 0.05).There was no significant difference in the average levels of inflammatory factors between the experimental group and the control group at T1(p >0.05).(2)The average lactic acid level of the experimental group at T1 was lower than that at T0,the difference was statistically significant(p < 0.05),while the average lactic acid level of the control group at T1 was not statistically significant compared with that at T0(p > 0.05).There was no significant difference in the average lactic acid level between the experimental group and the control group at T0(p > 0.05).The average lactic acid level of experimental group was lower than that of control group at T1,and the difference was statistically significant(p < 0.05).2.Risk factors for 28-day prognosis in patients with sepsisBinary Logistic regression analysis showed that IL-6,SOFA score and APACHE-II score were independent risk factors for poor prognosis in patients with sepsis.Further ROC curve analysis showed that: The area under the curve of SOFA score for predicting the death of sepsis patients within 28 days was 0.757,the sensitivity was 70.8%,and the specificity was 69.6%.The area under the curve of APACHE-II score for predicting the death of patients with sepsis within 28 days was 0.781,the sensitivity was 66.7%,and the specificity was 17.4%.The area under the curve of IL-6 level in predicting the death of sepsis patients within 28 days was0.804,the sensitivity was 79.2%,and the specificity was 21.7%.3.The effect of methylene blue on the condition changes and 28-day prognosis of patients with sepsis(1)The average SOFA score and APACHE-II score of the experimental group at T1 were lower than those at T0,with statistical significance(p < 0.05),while the average SOFA score and APACHE-II score of the control group at T1 had no statistical significance compared with T0(p > 0.05).There was no significant difference in SOFA score and APACHE-II score between experimental group and control group at T0(p > 0.05).The average APACHE-II score of experimental group was lower than that of control group at T1,and the difference was statistically significant(p < 0.05).(2)There was no significant difference in the average length of ICU stay and 28-day survival rate between the two groups(p < 0.05).Conclusion(s):1.Methylene blue can reduce the levels of CRP,IL-6,IL-8 and lactic acid in patients with sepsis,and has anti-inflammatory and microcirculation effects;2.SOFA score,APACHE-II score and elevated IL-6 level are independent risk factors for 28-day mortality in patients with sepsis,which have predictive value for clinical prognosis;3.Methylene blue can improve the condition of patients with sepsis,but does not shorten the length of ICU stay and improve the 28-day survival rate. |
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