β-受体阻滞剂对脓毒症早期急性低氧性呼吸衰竭患者的保护作用  

Protective effects ofβ-blockers on patients with acute hypoxemic respiratory failure in the early sepsis

作　　者：易玲娴 吴柳琳 张慧 郭金玲 杨阳 石红燕 周文静 胡美 YI Lingxian;WU Liulin;ZHANG Hui;GUO Jinling;YANG Yang;SHI Hongyan;ZHOU Wenjing;HU Mei(Department of Critical Care Medicine,PLA Strategic Support Force Characteristic MedicalCenter,Beijing.100101,China)

机构地区：[1]中国人民解放军战略支援部队特色医学中心重症医学科,北京100101

出　　处：《临床急诊杂志》2020年第10期794-799,共6页Journal of Clinical Emergency

摘　　要：目的:探索β受体阻滞剂对脓毒症早期急性低氧性呼吸衰竭(AHRF)患者临床特征及结局的影响。方法:回顾性收集2015-01-01—2019-12-31期间所有入住中国人民解放军战略支援部队特色医学中心重症医学科的脓毒症患者数据,根据入院后有无使用β受体阻滞剂分为β受体阻滞剂组和non-β受体阻滞剂组,比较两组患者血气指标、生化指标、循环状态以及机械通气天数、ICU住院天数、28 d存活情况。结果:总共有105例脓毒症早期AHRF患者纳入研究,其中β受体阻滞剂组47例,non-β受体阻滞剂组58例。与non-β受体阻滞剂组相比,β受体阻滞剂可以改善PO2和氧合指数,降低乳酸水平,增加淋巴细胞数量,减少血管活性药物的使用(P<0.05)。并且β受体阻滞剂可明显减少脓毒症早期AHRF患者的机械通气天数,ICU住院天数和28 d病死率(P<0.05)。多因素COX回归分析显示,β受体阻滞剂可以降低脓毒症早期AHRF患者的死亡风险(OR=0.781,95%CI:0.726~0.841,P<0.05),而高乳酸(OR=1.198,95%CI:1.178~1.218,P<0.01)、高SOFA评分(OR=1.222,95%CI:1.207~1.238,P<0.01)以及男性(OR=1.676,95%CI:1.559~1.806,P<0.01)可增加28 d病死率。结论:β受体阻滞剂是脓毒症早期AHRF患者的保护因素,而高乳酸、高SOFA评分以及男性是危险因素。Objective:To explore the effect ofβ-blockers on the clinical characteristics and outcome of patients with acute hypoxemic respiratory failure(AHRF)in early sepsis.Method:The data were retrospectively collected from sepsis patients who were admitted to the Department of Critical Medicine of PLA Strategic Support Force Characteristic Medical Center from January 1,2015 to December 31,2019.The patients were divided into two groups,β-blocker group and non-β-blocker group,according to the use ofβ-blockers after admission.The blood gas indexes,biochemical indexes,circulatory state indexes,days of mechanical ventilation,length of ICU stay,and 28-day survival were compared between the two groups.Result:A total of 105 patients with AHRF in the early sepsis were enrolled in the study,including 47 patients in theβ-blocker group and 58 patients in the non-β-blocker group.Compared with non-β-blocker group,β-blockers group improved PO2 and oxygenation index,decreased the level of lactic acid,increased the number of lymphocytes and reduced the dose of vasoactive drugs(P<0.05).The days of mechanical ventilation,length of ICU stay,and 28-day mortality of AHRF patients in the early sepsis significantly reduced in theβ-blocker group(P<0.05).In multivariate COX regression analysis,β-blockers reduced the risk of death in AHRF patients with early sepsis(OR=0.781,95%CI:0.726-0.841,P<0.05),while high lactic acid level(OR=1.198,95%CI:1.178-1.218,P<0.01),high SOFA score(OR=1.222,95%CI:1.207-1.238,P<0.01)and male(OR=1.676,95%CI:1.559-1.806,P<0.01)increased 28-day mortality significantly.Conclusion:β-blockers were protective for AHRF patients in early sepsis,while high lactic acid level,high SOFA score and male were risk factors.

关 键 词：Β受体阻滞剂 脓毒症 急性呼吸衰竭 SOFA评分 病死率 

分 类 号：R631.2[医药卫生—外科学]