早期预防性应用艾司洛尔对脓毒症导致心功能障碍发生率、心功能及心率减速力的影响

摘要

Objective To investigate the effect of early phase esmolol treatment to prevent sepsis induced myocardial dysfunction(SIMD)and improve deceleration capacity(DC)in patients with sepsis.Methods Ninety sepsis patients were enroll from Nanjing integrated Chinese and Western Medicines Hospital from January.2015 to April,2017.All the patients were divided into two groups:esmolol group(n=40)and control group(n=50).NT-proBNP,cTnI,cardiac ultrasound and DC were compared and analyzed at T 0(when the patients enrolled the study)and T1(when the patients diagnosed SIMD).Re-sults The morbidity of SIMD in esmolol group were decreased compared with those in control group(42.5%vs.58%,χ2=5.145,P<0.05).In T1phase,the levels of NT-proBNP(t=2.567,P=0.008)and LVEDD(t=1.782,P=0.042)in control group were increased in comparison of control group,while LVEF(t=2.052,P=0.024)and DC(t=2.419,P=0.011)were decreased.Only NT-proBNP was elevated in esmolol group in T 1phase(t=2.107,P=0.022).The levels of NT-proBNP in esmolol group were lower than those in control group(t=2.455,P=0.010),while levels of LVEF were higher than those in control group(t=2.607,P=0.007).Correlation analysis showed that DC(r=0.637,P<0.05)and esmolol (r=0.685,P<0.05)was negatively associated with the morbidity of SIMD.DC was negatively related with esmolol(r=0.699,P<0.05).Logistic regression analysis showed that esmolol could reduce the morbidity of SIMD by 22%,while every 1 ms of DC could increase the morbidity by 27%.Conclusion Early phase esmolol intervention may improve the fluctuation of DC and reduce the morbidity of SIMD in sepsis patients.%目的 观察脓毒症患者早期应用艾司洛尔对脓毒症导致心功能障碍(SIMD)发生率、心功能及心率减速力(DC)的影响.方法 收集2015年1月—2017年4月南京市中西医结合医院诊治的脓毒症患者90例,根据是否应用艾司洛尔分为观察组(n=40)和对照组(n=50),比较2组入组时(T0)、诊断SIMD时(T1)N末端脑钠肽前体(NT-proBNP)、心脏功能、肌钙蛋白I(cTnI)、心脏超声和DC水平波动情况.结果 观察组患者SIMD发生率明显低于对照组(42.5%vs.58.0%,χ2=5.145,P<0.05).T1时对照组患者NT-proBNP和LVEDD均明显上升,而LVEF和DC水平明显下降(t=2.567、1.782、2.052、2.419,P=0.008、0.042、0.024、0.011),而观察组仅可见NT-proB-NP明显上升(t=2.107,P=0.022).T1时观察组NT-proBNP明显低于对照组(t=2.455,P=0.010),而LVEF明显高于对照组(t=2.607,P=0.007).与T0比较,SIMD2亚组患者T1时NT-proBNP和LVEDD水平均明显升高(P<0.05),而LVEF和E/A水平均明显降低(P<0.05),未用艾司洛尔亚组DC水平明显降低(P<0.05);T1时艾司洛尔亚组NT-proBNP明显低于未用艾司洛尔亚组(P<0.05),而LVEF和DC明显高于未用艾司洛尔亚组(P<0.05).相关性分析提示△DC(r=-0.637,P<0.05)和艾司洛尔干预治疗(r=-0.685,P<0.05)均与SIMD的发生呈负相关.△DC与艾司洛尔干预治疗之间呈负相关(r=-0.699,P<0.05).Logistic回归分析表明使用艾司洛尔治疗后可以使SIMD发生风险降低22%(P=0.002),△DC每增加1ms可以使SIMD风险升高27%(P=0.007).结论 脓毒症患者早期应用艾司洛尔可以明显改善DC的波动幅度并且降低SIMD的发病率.