Protective effect of methylene blue on postoperative liver and kidney functions in patients with obstructive jaundice

• Main Authors: WANG Moran, HUANG Jian, ZHANG Ning, ZHU Yuan, XIANG Lunli, LU Kaizhi, NING Jiaolin
• Format: Article
• Language: zho
• Published: Editorial Office of Journal of Third Military Medical University 2021-07-01
• Series: Di-san junyi daxue xuebao
• Subjects: obstructive jaundice; methylene blue; liver and kidney functions; organ protection
• Online Access: http://aammt.tmmu.edu.cn/Upload/rhtml/202102014.htm

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 between the 2 groups of patients (P>0.05). The methylene blue group had significantly less amounts of Ringer's lactate solution (1 788.22±562.67 vs 2 635.32±633.45 mL) and norepinephrine (1.43±0.42 vs 4.11±1.14 mg), and lower ratio of norepinephrine use (32% vs 52%) than the placebo group (P < 0.01). The extubation time and ICU stay time were obviously shorter in the former than the latter group (P < 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 (P>0.05). The postoperative levels of aspartate aminotransferase in 24 h (200.21±143.33 vs 362.32±253.64 IU/L) and 72 h (123.32±87.44 vs 184.53±143.25 IU/L) and those of alanine aminotransferase at 24 h (192.52±83.23 vs 254.24±93.22 IU/L) and 72 h (183.31±107.92 vs 276.34±111.95 IU/L) were notably lower in the methyl blue group than the placebo group (P < 0.05). No significant difference were seen in the postoperative levels of creatinine and urea nitrogen between the 2 groups (P>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.