Effect Of Methylene Blue On Tissue Perfusion In Patients With Septic Shock

Objective(s):Sepsis and septic shock are common syndromes in critical care medicine,and the mortality rate from septic shock remains high year after year.In clinical work,for adult patients with sepsis or septic shock,we use a mean arterial pressure greater than 65 mm Hg as the target blood pressure,so high doses of vasoactive drugs are often required,and high doses of vasoactive drugs may bring serious side effects.In contrast,methylene blue has demonstrated positive effects such as improvement of mean arterial pressure in septic shock in several foreign reports,and no serious complications were found.There are few high-quality randomized controlled trial studies on the timing of methylene blue administration in septic shock at home and abroad,and there are no specific protocols for the frequency of administration and the dose of drug use.The purpose of this study was to investigate whether the use of methylene blue in septic shock patients could improve the mean arterial pressure,tissue perfusion,and reduce the dose of other vasoactive drugs in patients.To provide more options to save septic shock patients in the future and reduce the mortality of septic shock.Methods:This study was a prospective experiment to collect data from 65 patients with septic shock admitted to the Department of Intensive Care Medicine of the First People’s Hospital of Yunnan Province from December 2021 to April 2023.The study population was finally identified as 58 cases according to the inclusion and exclusion criteria,including 28 cases in the control group,and the patients with septic shock in this group were treated according to the 2021 guidelines for the management of sepsis and septic shock.In the experimental group,30 patients with septic shock were treated with methylene blue on top of the standard treatment according to the "2021 guidelines for the management of sepsis and septic shock".After patients were admitted to the intensive care unit,general information such as name,sex and age of all patients with septic shock were collected,cardiac monitoring and blood tests were completed within30 minutes after admission,and vital signs and related test results were collected.According to the inclusion and exclusion criteria,the patients who met the criteria were randomly divided into experimental and control groups,and the patients in the experimental group were treated with methylene blue within 24 hours,and the patients’ vital signs and related blood test results were monitored at different times before and after the infusion of methylene blue,and the same data were collected from the control group at the same time point.The data collected from the experimental and control groups were collated and then statistically analyzed.The study was statistically analyzed using SPSS26.0 software,and the difference was statistically significant at P<0.05.Results:There was no statistically significant difference between the experimental and control groups in age,gender,respiratory rate,heart rate,CVP,white blood cell count,calcitoninogen,blood creatinine,glutamic aminotransferase,glutamic oxalacetic aminotransferase,total bilirubin,direct bilirubin,indirect bilirubin,PH,24-hour urine output,APACHE II score,and SOFA score(P>0.05).Therefore,there was no significant difference between the two groups before the intervention.Comparison of norepinephrine dose changes between the experimental and control groups suggested a P<0.05,indicating a significant time and group interaction with statistically significant differences between the two groups.Further simple effect analysis of the time and group interaction showed a statistically significant(P<0.05)comparison of the difference in the experimental group relative to the reduced norepinephrine dose at different time points.Comparison of blood lactate changes between the two groups suggested that P>0.05,indicating that the time and group interaction between the two groups was non-significant and not statistically different.A central venous mixed oxygen saturation(Scv O2)of 65%-75% was taken as the normal range.The starting central venous mixed oxygen saturation was taken as the starting point,and the change in central venous mixed oxygen saturation level was monitored at 3,6,and 24 hours,and was counted as positive if it changed from the starting non-normal range to normal.Pcv-a C02/Ca-v02 can reflect the tissue perfusion of patients,and the study showed that Pcv-a C02/Ca-v02< 1.4 indicates good tissue supply under aerobic metabolism,and vice versa.Pcv-a C02/Ca-v02≥ 1.4 indicates impaired tissue oxygenation under anaerobic metabolism.The starting Pcv-a C02/Ca-v02 was taken as the starting point,and the Pcv-a C02/Ca-v02 ratio was calculated again in both groups at 3 h,6 h,and 24 h.If the starting Pcv-a C02/Ca-v02 changed from 0.05)at 3,6,and 24 hours,and no more significant improvement in Pcv-a C02/Ca-v02 was found with methylene blue intervention in this study.Six patients in the experimental group used PICCO monitoring,and five patients in the control group used PICCO monitoring,the two groups of patients in SVRI,CI,GEDI data for comparative analysis,found that the experimental group and the control group in SVRI differences are statistically significant(P<0.05),the experimental group compared with the control group SVRI significantly improved,the two groups in CI,GEDI did not see significant statistical differences between the two groups in CI and GEDI(P>0.05).Conclusion(s):1.The differences of blood lactate,Sc VO2,Pcv-a C02/Ca-v02,CI,GEDI in the experimental group under methylene blue intervention were not statistically significant compared with the control group.2.Methylene blue showed significant improvement in peripheral vascular resistance.3.Methylene blue could reduce the use of norepinephrine in patients with septic shock.Dose.