Efficacy and Safety of Esmolol in Treatment of Patients wi Septic Shock  

作　　者：Wei Du Xiao-Ting Wang Yun Long Da-Wei Liu 

机构地区：[1]Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China

出　　处：《Chinese Medical Journal》2016年第14期1658-1665,共8页中华医学杂志（英文版）

摘　　要：Background： Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. Methods： Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate （HR） 〉100 beats/rain. Esmolol therapy achieved the target HR of 10-15% lower than the baseline HR. Clinical and physiological data of patients were collected prospectively within 1 h prior to esmolol therapy and 2 h after achieving the targeted HR. Results： Sixty-three patients were recruited. After esmolol therapy, blood pressure was unaltered, whereas stroke volume （SV） was increased compared with betbre esmolol therapy （43.6 ± 22.7 vs. 49.9 ±23.7 ml, t = -2.3, P = 0.047）. Tissue perfusion, including lactate levels （1.4 ± 0.8 vs. 1.1 ± 0.6 mmol/L, t = 2.6, P = 0.015） and the central venous-to-arterial carbon dioxide difference （5.6 ±3.3 vs. 4.3 ± 2.2 mmHg, t - 2.6 P = 0.016）, was also significantly decreased after esmolol therapy. For patients with increased SV （n = 42）, cardiac efficiency improved, and esmolol therapy had a lower risk for a decrease in cardiac output （CO）. Therefore, pretreatment cardiac systolic and diastolic parameters with （n = 42）/without 01 = 21 ） an increase in SV were compared. Mitral lateral annular plane systolic excursion （MAPSEIat） in patients with increased SV was significantly higher than that in those without increased SV （1.3 ±0.3 vs. 1.1 ± 0.2 cm, t = 2.4, P = 0.034）. Conclusions： SV of septic shock patients is increased is llowing esmolol therapy. Although CO is also decreased with HR, tissue perfusion is not worse.Background： Previous studies have suggested that β1-receptor blockers benefit septic shock patients. This study aimed to determine whether β1-receptor blockers benefit tissue perfusion in sepsis and to identify parameters to reduce the risk of this drug in sepsis. Methods： Consecutive septic shock patients were recruited from the Intensive Care Unit of Peking Union Medical College Hospital within 48 h of diagnosis. All patients were hemodynamically stable and satisfactorily sedated with a heart rate （HR） 〉100 beats/rain. Esmolol therapy achieved the target HR of 10-15% lower than the baseline HR. Clinical and physiological data of patients were collected prospectively within 1 h prior to esmolol therapy and 2 h after achieving the targeted HR. Results： Sixty-three patients were recruited. After esmolol therapy, blood pressure was unaltered, whereas stroke volume （SV） was increased compared with betbre esmolol therapy （43.6 ± 22.7 vs. 49.9 ±23.7 ml, t = -2.3, P = 0.047）. Tissue perfusion, including lactate levels （1.4 ± 0.8 vs. 1.1 ± 0.6 mmol/L, t = 2.6, P = 0.015） and the central venous-to-arterial carbon dioxide difference （5.6 ±3.3 vs. 4.3 ± 2.2 mmHg, t - 2.6 P = 0.016）, was also significantly decreased after esmolol therapy. For patients with increased SV （n = 42）, cardiac efficiency improved, and esmolol therapy had a lower risk for a decrease in cardiac output （CO）. Therefore, pretreatment cardiac systolic and diastolic parameters with （n = 42）/without 01 = 21 ） an increase in SV were compared. Mitral lateral annular plane systolic excursion （MAPSEIat） in patients with increased SV was significantly higher than that in those without increased SV （1.3 ±0.3 vs. 1.1 ± 0.2 cm, t = 2.4, P = 0.034）. Conclusions： SV of septic shock patients is increased is llowing esmolol therapy. Although CO is also decreased with HR, tissue perfusion is not worse.

关 键 词：ECHOCARDIOGRAPHY Esmolol： Myocardial Depression Septic Shock 

分 类 号：TQ463.4[化学工程—制药化工] S858.292[农业科学—临床兽医学]