血管麻痹性休克患者的红绿双色尿液

Christmas-colored urine in vasoplegic shock

• A 73-year-old male underwent redo mitral valve replace-ment.Cardiopulmonary bypass time was prolonged and the case was complicated by significant hypotension.He arrived to the ICU on multiple vasopressors in refractory vasoplegic shock.Methylene blue was  administered and then high-dose  hydroxocobalamin as salvage agents.These agents are nitric oxide scavengers and their use has increased in the treatment of vasoplegic syndrome. Both agents can cause benign changes to urine color. The patient’s urine was first noted to be green-blue as is commonly seen with methylene blue administration. After administration of hydroxocobalamin, urine color then changed to a maroon-red, also a known side effect of this medication, which can last for over a week. These distinct color changes were visualized in the foley bag, correlating with timing of administration (Fig. 1, black arrow). Over the next 24 h, shock improved and the patient was weaned off vasopressors and made a complete recovery.
  

血管麻痹性休克患者的红绿双色尿液

• 一位73岁的男性进行第二次二尖瓣置换术。由于心肺旁路手术时间延长以及并发严重的低血压，病人到达ICU时因难治性血管麻痹性休克使用多种升压药。
  

• 给予患者亚甲基蓝以及高剂量的羟钴胺进行抢救性治疗。这些药物为一氧化氮清除剂，被越来越多地应用到血管麻痹综合症的治疗中。这两种药物都能引起尿液颜色的良性改变。服用亚甲基蓝后，患者的尿液通常先呈蓝绿色，给予羟钴胺后，尿液的颜色接着变为红褐色，这是一种该药物治疗的已知副作用，通常会持续超过一周。这种独特的颜色变化在尿袋中可以观察到，与给药的时间有关（图1 黑色箭头）。在接下来的24小时内，休克得到改善，患者停止使用升压药并且完全恢复。
  
  

图1