β1-受体阻滞剂控制心率对感染性休克患者血流动力学和预后的影响  

The effect of heart rate control of β1-Receptor Antagonists on Hemodynamics and prognosis in patients with septic shock

作　　者：刘振兴[1] 白祥琰 李维[1] 桂峰[1] 艾芬[1] 汪一帆[1] LIU Zhenxing BAI Xiangyan LI Wei GUI Feng AI Fen WANG Yi fan(Department of Emergency, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Teehnology,Wuhan 430014,China)

机构地区：[1]华中科技大学同济医学院附属武汉中心医院急诊科,武汉430014

出　　处：《临床急诊杂志》2017年第7期522-525,共4页Journal of Clinical Emergency

摘　　要：目的:探讨对感染性休克患者应用β1-受体阻滞剂控制心率对血流动力学以及预后的影响。方法:选取2012-01-2016-10我院重症监护病房收治的80例感染性休克患者为研究对象,随机分为对照组和观察组,每组40例。对照组给予常规抗感染性休克治疗,观察组在此基础上给予静脉注射盐酸艾司洛尔注射液。记录比较2组治疗前(T1)及治疗后24h(T2)、48h(T3)、72h(T4)的各项血流动力学指标、左室射血分数(LVEF)、左室舒张末期直径(LVEDD)及E峰与A峰比值(E/A),并对比2组住院期间的并发症发生率及病死率。结果:观察组心率在用药后明显下降,在24h、48h、72h时均低于对照组(P<0.05);2组MAP、SpO2比较,差异无统计学意义。治疗前2组患者心脏功能指标比较差异无统计学意义;治疗后观察组LVEDD、LVEF与E/A均高于对照组,差异具有统计学意义(P<0.05)。观察组急性肾损伤、急性呼吸窘迫综合症(ARDS)的发生率均低于对照组(P<0.05),此外观察组病死率为52.5%,显著低于对照组的85.0%,差异具有统计学意义(P<0.05)。结论:感染性休克患者使用β1-受体阻滞剂,可有效控制心率,改善心室的顺应性以及舒张功能,提高组织灌注水平,减轻对脏器的损伤,改善患者预后,因此可作为临床治疗感染性休克的有效药物选择之一。Objective：To investigate the effect of heart rate control ofβ1-receptor antagonists on hemodynamics and prognosis in patients with septic shock.Method：Eighty patients with septic shock admitted to intensive care unit in our hospital from January 2012 to October 2016 were selected as study subject.The control group was given conventional anti-septic shock treatment;on this basis,the observation group was given intravenous injection of esmolol hydrochloride.Various haemodynamics index,left ventricular ejection fraction（LVEF）,left ventricular end diastolic diameter（LVEDD）and the specific value of E peak and A peak regarding prior treatment（T1）and posttreatment 24h（T2）、48h（T3）、72h（T4）in two groups with complication and case fatality rate during hospitalization in two groups recorded and compared.Result：The HR in the observation group was significantly decreased after treatment and it was all lower than the control group（P〈0.05）in the 24 h,48hand 72h;There was no significant difference for MAP、SpO2in two groups.The LVEDD,LVEF and E/A in observation group were all higher than those in the control group,with significant difference（P〈0.05）.The occurrence rate of acute kidney injury and acute respiratory distress syndrome（ARDS）in observation group was all lower than those in control group（P〈0.05）.Besides,the death rate of observation group was 52.5%,which was significantly lower than 85.0% in control group so that the difference was of statistic significance.Conclusion：Patients with septic shock who applyβ1-receptor antagonist can effectively control the heart rate,improve ventricular compliance diastolic function,increase tissue perfusion level,reduce viscera damage and improve the patients＇ prognosis so that it can be served as one of the effective drugs for the treatment of septic shock.

关 键 词：Β1-受体阻滞剂 心率 感染性休克 血流动力学 预后 

分 类 号：R459.7[医药卫生—急诊医学]