美托洛尔对感染性休克早期心肌损伤患者血流动力学的影响  

Effects of Metoprolol on Hemodynamics of Early Septic Shock Patients with Myocardial Injury

作　　者：池锐彬[1] 雷玲[1] 简志刚[1] 刘力新[1] 

机构地区：[1]南方医科大学附属小榄医院重症医学科,广东中山528415

出　　处：《中国呼吸与危重监护杂志》2016年第1期53-56,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的探讨美托洛尔对感染性休克早期心肌损伤患者血流动力学的影响。方法前瞻性选择2014年3月至2015年2月在南方医科大学附属小榄医院ICU住院的22例感染性休克早期合并心肌损伤患者作为研究对象。通过中心静脉注射美托洛尔使心率下降20%,并持续静脉维持6 h,动态连续收集血流动力学及氧代谢参数建立数据库。结果给药后1、3和6h患者心率分别为(98±18)、(95±16)和(92±18)次/min,比给药前心率(125±28)次/min明显降低(P<0.05)。给药后1、3和6 h患者心排指数分别为(3.2±1.5)、(3.3±1.9)、(3.3±1.6)L·min^(-1)·m^(-2),比给药前(3.9±2.5)L·min^(-1)·m^(-2)显著降低(P<0.05)。给药前后平均动脉压、中心静脉压、肺动脉嵌顿压、肺循环阻力指数、体循环阻力指数、每搏量指数等均无显著变化(P>0.05)。给药后3和6h血乳酸水平为(9.8±4.1)和(8.1±3.6)mmol/L,与治疗前(13.4±5.2)mmol/L比较差异有统计学意义(P<0.05)。治疗前后混合静脉血氧饱和度比较差异无统计学意义(P>0.05)。结论美托洛尔能够有效降低感染性休克早期心肌损伤患者的心率和心排出量,但对循环功能和全身组织灌注无明显影响。Objective To explore the effects of metoprolol on hemodynamics of early septic shock patients with myocardial injury. Methods We prospectively recruited 22 septic shock patients with myocardial injury, who were admitted to the ICUof Xiaolan Hospital during March2014 and February 2015. The metoprolol was injected through central venous catheter to reduce heart rate by 20% from baseline and maintain for 6h. Hemodynamic and oxygen metabolic parameters were collected to establish database. Results Heart rate decreased significantly to （ 98 ±18） , （ 95 ±16） and （ 92 ±18） beat/min respectively at 1h, 3h and 6h post-dosing, compared with （ 125 ±28） beat/min at pre-dosing （ P 〈0. 05） . Cardiac index decreased significantly to （ 3. 2 ±1. 5） , （ 3. 3 ±1. 9） and （ 3. 3 ±1. 6） L·min^-1·m^-2 respectively at 1h, 3h and 6h post-dosing, compared with （ 3. 9 ±2. 5） L· min^-1 · m^-2 at pre-dosing （ P 〈 0. 05） . The mean blood pressure, central venous pressure, pulmonary artery wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke volume index showed no significant changes between pre-dosing and post-dosing （ all P 〉0. 05） . Lactate concentration decreased significantly to （ 9. 8 ±4. 1） and （ 8. 1 ± 3. 6） mmol /L respectively at 3h and 6h post-dosing, compared with （ 13. 4 ±5. 2） mmol /L at pre-dosing （ all P 〈0. 05） , but mixed venous oxygen saturation showed no significant changes （ P 〉 0. 05） . Conclusion Metoprolol may reduce heart rate and cardiac output in septic shock patients with myocardial injury, without obvious adverse effects on circulatory function and systemic perfusion.

关 键 词：美托洛尔 感染性休克 心肌损伤 血流动力学 

分 类 号：R459.7[医药卫生—急诊医学]