亚甲蓝对梗阻性黄疸患者术后肝肾功能的保护作用

王漠然; 黄艰; 张宁; 朱圆; 向伦理; 鲁开智; 甯交琳

doi:10.16016/j.1000-5404.202102014

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亚甲蓝对梗阻性黄疸患者术后肝肾功能的保护作用

临床医学 | 更新时间：2026-01-09

- 亚甲蓝对梗阻性黄疸患者术后肝肾功能的保护作用
- Protective effect of methylene blue on postoperative liver and kidney functions in patients with obstructive jaundice
- 第三军医大学学报 2021年43卷第14期页码：1379-1383
- 作者机构：
  
  400038 重庆，陆军军医大学(第三军医大学)第一附属医院麻醉科
- 作者简介：
  
  [ 甯交琳，E-mail: NJiaolin1976@126.com NING Jiaolin, E-mail: NJiaolin1976@126.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202102014
  中图分类号： R657.4;R969.4;R972.5
- 收稿：2021-02-02，
  
  修回：2021-03-29，
  
  纸质出版：2021-07-30
- 稿件说明：
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王漠然, 黄艰, 张宁, 等. 亚甲蓝对梗阻性黄疸患者术后肝肾功能的保护作用[J]. 第三军医大学学报, 2021,43(14):1379-1383.

Moran WANG, Jian HUANG, Ning ZHANG, et al. Protective effect of methylene blue on postoperative liver and kidney functions in patients with obstructive jaundice[J]. Journal of Third Military Medical University, 2021, 43(14): 1379-1383.
王漠然, 黄艰, 张宁, 等. 亚甲蓝对梗阻性黄疸患者术后肝肾功能的保护作用[J]. 第三军医大学学报, 2021,43(14):1379-1383. DOI： 10.16016/j.1000-5404.202102014.

Moran WANG, Jian HUANG, Ning ZHANG, et al. Protective effect of methylene blue on postoperative liver and kidney functions in patients with obstructive jaundice[J]. Journal of Third Military Medical University, 2021, 43(14): 1379-1383. DOI： 10.16016/j.1000-5404.202102014.

摘要

目的

探讨术中输注亚甲蓝对梗阻性黄疸患者术后肝肾功能的影响。

方法

纳入2019年7月至2020年12月于本院行胆道梗阻解除手术、血清总胆红素高于34.2 μmol/L的黄疸患者，用随机数字表法将患者分为两组(

=25): 亚甲蓝组麻醉插管前以2 mg/kg亚甲蓝50 mL输注给药并在术中以0.5 mg/(kg·h)持续输注；安慰剂组术中全程输注等量生理盐水。比较两组患者术中平均动脉压、出入量、去甲肾上腺素使用情况，术后氧

合指数、总胆红素、总胆汁酸、谷草转氨酶、谷丙转氨酶、肌酐和尿素氮。

结果

两组患者术中平均动脉压差异无统计学意义；亚甲蓝组患者的乳酸林格氏液[(1 788.22±562.67)mL

(2 635.32±633.45)mL

]

、去甲肾上腺素[(1.43±0.42)mg

(4.11±1.14)mg

]

和去甲肾上腺素使用率(32%

52%)均较安慰剂组少(

0.01)；亚甲蓝组的拔管时间及ICU停留时间均较安慰剂组时间短(

0.05)；两组患者术后氧合指数差异无统计学意义；两组患者术后总胆红素和总胆汁酸差异无统计学意义；亚甲蓝组患者谷草转氨酶在术后24 h[(200.21±143.33) IU/L

(362.32±253.64) IU/L

]

和72 h[(123.32±87.44) IU/L

(184.53±143.25) IU/L

]

较安慰剂组患者降低，亚甲蓝组患者谷丙转氨酶在术后24 h[(192.52±83.23)IU/L

(254.24±93.22)IU/L

]

和72 h[(183.31±107.92)IU/L

(276.34±111.95)IU/L

]

较安慰剂组降低(

0.05)；两组患者肌酐及尿素氮术后差异无统计学意义。

结论

梗阻性黄疸患者术中持续输注亚甲蓝可减少升压药的使用，有效缓解术后肝脏功能损害，提高患者围术期安全。

Abstract

Objective

To determine the effect of intraoperative methylene blue infusion on postoperative liver and kidney functions in patients with obstructive jaundice.

Methods

A total of 50 patients with serum total bilirubin level higher than 34.2 μmol/L undergoing biliary obstruction surgery in our hospital from July 2019 to December 2020 were included in this study. They were randomly and equally divided into methylene blue group (infusion of 50 mL 2 mg/kg methylene blue before anesthesia intubation followed by 0.5 mg·kg

-1

·h

-1

continuous infusion during the operation) and placebo group (same amount of normal saline throughout the operation). Intraoperative mean arterial pressure

intake and output and norepinephrine usage

and postoperative oxygenation index

and the levels of total bilirubin

total bile acid

aspartate aminotransferase

alanine aminotransferase

creatinine and urea nitrogen were compared between the 2 groups.

Results

There was no significant difference in the mean arterial pressure be

tween the 2 groups of patients (

0.05). The methylene blue group had significantly less amounts of Ringer's lactate solution (1 788.22±562.67

2 635.32±633.45 mL) and norepinephrine (1.43±0.42

4.11±1.14 mg)

and lower ratio of norepinephrine use (32%

52%) than the placebo group (

0.01). The extubation time and ICU stay time were obviously shorter in the former than the latter group (

0.05). But there were no statistical differences in postoperative oxygenation index or postoperative levels of total bilirubin and total bile acid between the 2 groups (

0.05). The postoperative levels of aspartate aminotransferase in 24 h (200.21±143.33

362.32±253.64 IU/L) and 72 h (123.32±87.44

184.53±143.25 IU/L) and those of alanine aminotransferase at 24 h (192.52±83.23

254.24±93.22 IU/L) and 72 h (183.31±107.92

276.34±111.95 IU/L) were notably lower in the methyl blue group than the placebo group (

0.05). No significant difference were seen in the postoperative levels of creatinine and urea nitrogen between the 2 groups (

0.05).

Conclusion

Continuous infusion of methylene blue reduces the use of blood pressure drugs in patients with obstructive jaundice

effectively alleviates postoperative liver damage

and thus improves patient safety during the perioperative period.

关键词

Keywords

references

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