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首页> 外文期刊>Sao Paulo Medical Journal >Methylene blue for clinical anaphylaxis treatment: a case report
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Methylene blue for clinical anaphylaxis treatment: a case report

机译：亚甲蓝用于临床过敏反应的治疗：一例报告

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CONTEXT AND OBJECTIVE: Nitric oxide has a pathophysiological role in modulating systemic changes associated with anaphylaxis. Nitric oxide synthase inhibitors may exacerbate bronchospasm in anaphylaxis and worsen clinical conditions, with limited roles in anaphylactic shock treatment. The aim here was to report an anaphylaxis case (not anaphylactic shock), reversed by methylene blue (MB), a guanylyl cyclase inhibitor. CASE REPORT: A 23-year-old female suddenly presented urticaria and pruritus, initially on her face and arms, then over her whole body. Oral antihistamine was administered initially, but without improvement in symptoms and signs until intravenous methylprednisolone 500 mg. Recurrence occurred after two hours, plus vomiting. Associated upper respiratory distress, pulmonary sibilance, laryngeal stridor and facial angioedema (including erythema and lip edema) marked the evolution. At sites with severe pruritus, petechial lesions were observed. The clinical situation worsened, with dyspnea, tachypnea, peroral cyanosis, laryngeal edema with severe expiratory dyspnea and deepening unconsciousness. Conventional treatment was ineffective. Intubation and ventilatory support were then considered, because of severe hypoventilation. But, before doing that, based on our previous experience, 1.5 mg/kg (120 mg) bolus of 4% MB was infused, followed by one hour of continuous infusion of another 120 mg diluted in dextrose 5% in water. Following the initial intravenous MB dose, the clinical situation reversed completely in less than 20 minutes, thereby avoiding tracheal intubation. CONCLUSION: Although the nitric oxide hypothesis for MB effectiveness discussed here remains unproven, our intention was to share our accumulated cohort experience, which strongly suggests MB is a lifesaving treatment for anaphylactic shock and/or anaphylaxis and other vasoplegic conditions.
机译：背景与目的：一氧化氮在调节与过敏反应有关的全身性变化中具有病理生理作用。一氧化氮合酶抑制剂在过敏性反应中可能加重支气管痉挛并加重临床状况，在过敏性休克治疗中作用有限。本文的目的是报告一种过敏性病例（不是过敏性休克），并被鸟苷酸环化酶抑制剂亚甲蓝（MB）逆转。病例报告：一名23岁的女性突然出现荨麻疹和瘙痒症，最初是在她的脸上和手臂上，然后是整个身体。最初口服口服抗组胺药，但症状和体征没有改善，直到静脉注射甲基强的松龙500 mg。两小时后，加上呕吐，复发。伴随的上呼吸窘迫，肺功能异常，喉咙喘鸣和面部血管性水肿（包括红斑和唇部水肿）标志着进化。在严重瘙痒的部位，观察到有皮疹的病变。临床情况恶化，出现呼吸困难，呼吸急促，经口发，喉头水肿，伴有严重的呼气困难和意识增强。常规治疗无效。由于严重的通气不足，因此考虑了插管和通气支持。但是，在此之前，根据我们以前的经验，先输注1.5 mg / kg（120 mg）4％MB的大剂量药丸，然后连续一小时再输注另一只120 mg用5％葡萄糖稀释的水。最初的静脉内MB剂量后，临床情况在不到20分钟的时间内完全扭转，从而避免了气管插管。结论：尽管此处讨论的关于MB有效性的一氧化氮假说尚未得到证实，但我们的目的是分享我们积累的队列研究经验，这强烈表明MB是用于过敏性休克和/或过敏性反应和其他血管异常状态的挽救生命的治疗方法。

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