脓毒血症患者心脏和微循环的功能变化及β-受体阻滞剂治疗的血流动力学效应  

Functional Changes of Heart and Microcirculation in Patients with Sepsis and Analysis of the Hemodynamic Effects of Beta Blockers

作　　者：郑天勇 周天恩[2] 肖建新 韦海潮 ZHENG Tian-yong;ZHOU Tian-en;XIAO Jian-xing;WEI Hai-chao(Department of Outpaint Clinic,Affiliated Xiaolan Hospital,Southern Medical University,528415;Department of Emergency,Sun Yat-sen Memorical Hospital of Sun Yat-sen University,Guangzhou)

机构地区：[1]南方医科大学附属小榄医院门诊部,5284152 [2]中山大学孙逸仙纪念医院急诊科

出　　处：《岭南急诊医学杂志》2018年第4期309-311,330,共4页Lingnan Journal of Emergency Medicine

摘　　要：目的:探讨β-受体阻滞剂艾司洛尔对脓毒血症患者心脏及微循环功能及血流动力学指标的影响。方法:选择2016年4月-2016年8月中山大学附属孙逸仙纪念医院收治的脓毒血症患者34例,在经过标准治疗后给予患者β-受体阻滞剂盐酸艾司洛尔。比较用药前后脓毒症患者心脏的收缩及舒张功能、各项心功能综合指标、血压以及心肌酶的变化。结果:与用药前比较,用药后左室射血分数(LVEF)明显减少[(59.5±13.4)%vs(63.7±13.8)%,P<0.05];缩短分数明显变小[(31.0±8.0)%vs(34.6±10.1)%,P<0.05];舒张晚期血流速度明显降低[(85.6±12.2)cm/s vs(74.5±10.5)cm/s,P<0.05];峰减速时间明显增加[(125.3±16.1)ms vs(105.5±19.6)ms,P<0.05];二尖瓣环侧壁A明显降低[(10.0±1.4)cm/s vs(11.2±2.1)cm/s,P<0.05]。收缩末直径、收缩末容积、左室流出道VTI较用药前明显升高(P<0.05);心率较用药前明显降低(P<0.05);左心Tei指数无明显增加[(0.55±0.09)vs(0.42±0.06),P>0.05];左心室流出道的每搏量明显升高(P<0.05);血压参数及心肌酶无明显变化(P>0.05)。结论:β-受体阻滞剂艾司洛尔可引起脓毒血症患者心脏收缩及松弛功能下降,改善心脏顺应性,左心室流出道的每搏量出现上升趋势。Objective：To explore the influence of receptor blockers on the heart and circulation function,hemodynamic parameters in patients with sepsis. Methods：34 patients with sepsis were choosed from Apr 2016 to Aug 2016 in general medicine of Sun Yat-sen Memorial Hospital. After the standard treatment,the patient was given a beta blocker,esmolol hydrochloride. Used ultrasound to monitor the heart,before and after medication and comparative evaluation respectively before and after medication cardiac systolic and diastolic function in patients with sepsis,the cardiac function comprehensive indexes,blood pressure and the change of myocardial enzyme. Results：Compared the used beta blockers,the left ventricular ejection fraction（LVEF）,the score,late diastolic blood flow velocity and mitral valve ring wall before A was significantly reduced（59.5±13.4）% vs（63.7±13.8）%,（31.0±8.0%）vs（34.6±10.1）%,（74.5±10.5）cm/s vs（85.6±12.2）cm/s and（10.0±1.4）cm/s vs（11.2±2.1）cm/s respectively,all P〈0.05. The peak deceleration time,diameter and the volume at the end of the contraction and left ventricular outflow tract VTI significantly increased after used beta blockers,all P〈0.05. Heart rate was significantly lower than before medication,P〈0.05. Left heart Tei index increased from（0.42±0.06）before medication to medication after（0.55±0.09）,P〉0.05. The systolic and diastolic diameter at the end of the line computing EDV,ESV and finally deduces the SV increased,all P〈0.05. Use of beta blockers patients before and after The blood pressure parameters were not obvious changes,as well as in myocardial enzyme after used beta blockers,both P〉0.05. Conclusions：Beta blockers can cause patients cardiac contraction and relaxation function decline,improve compliance,SV rise trend,cardiac output decreases obviously.

关 键 词：脓毒血症 受体阻滞剂 血流动力学 微循环 

分 类 号：R459.7[医药卫生—急诊医学]