超短效β受体阻滞剂对严重脓毒症患者组织灌注的影响

摘要

Objective To investigate the effect of the ultra short-acting beta blockeresmololon tissue infusion in patients with severe sepsis.Methods We performed the prospective cohort study.151 patients with severe sepsis admitted to department of intensive care unit of Fujian Provincial Hospital were enrolled.The patients were divided into treatment group(n=75)and control group(n=76).The patients in both groups were given the standard treatment,thatis,esmolol was giving to patients in-treatment group to control the heart rate(HR)at between 75 min-1 and 100 min-1 for their ICU stay,while the patients in control group only received standard treatment.The changes in hemodynamic parameters,biochemistry metabolic of tissue,before and 24,48,72 hours after the treatment were recorded.Results(1)Targeted heart rates were achieved in all patients in the esmolol group compared with those in the control group.(2)The PvaCO2and the Lac of the same group were significantly different in every point of the treatment(P<0.05).The ScvO2 was increased in the treatment groups but decreased in the control groups(P<0.01).Between the Lac of treatment group and control group there were no significant differences(P>0.05).(3)The 28-day mortality and the length of ICU stay had no significant difference between the two groups(P>0.05),and the length of ventilator of treatment in the treatment group was reduced compared with control group(P<0.05).Conclusions For patients in severe sepsis,the short-acting β-blocker esmolol can reduce the length of ventilator and decrease the heart rate to the target level,however it has no influence on the circulation function and tissue perfusion.%目的 探讨超短效β受体阻滞剂艾司洛尔对严重脓毒症患者组织灌注的影响.方法 采用前瞻性队列研究方法,收集严重脓毒症患者151例,并分为治疗组(75例)和对照组(76例).2组均按常规方法治疗脓毒性休克,治疗组同时经中心静脉用微量泵持续泵入艾司洛尔,并在72 h内维持心率为75～100 min-1.观察2组患者治疗前及治疗后24,48,72 h的血流动力学及组织灌注指标,同时记录2组患者住ICU和使用呼吸机的时间.结果(1)治疗后,2组患者的心率均在试验开始72 h内达到目标水平.(2)各时间点组内比较动脉血乳酸(Lac)、动静脉血二氧化碳分压差,差别均有统计学意义(P<0.05);随时间变化,治疗组的中心静脉血氧饱和度(ScvO2)呈上升趋势,而对照组则呈下降趋势(P<0.01);治疗组与对照组的Lac下降速度差别无统计学意义(P>0.05).(3)治疗组和对照组的28 d死亡率和住ICU时间差别无统计学意义(P>0.05);而机械通气时间差别有统计学意义(P<0.002).结论 超短效β受体阻滞剂艾司洛尔能显著控制严重脓毒症患者的心率,减少机械通气时间,对循环功能及组织灌注无明显影响.