长期口服β受体阻滞剂对脓毒症患者心肌损伤及预后的影响  

Effects of long-term oral administration of β-blocker on septic myocardial injury and prognosis

作　　者：杨春[1] 余丹凤[1] 常春阳[1] 朱高尚 袁玉霞 赖志珍[2] 孟建标[2] 李海林[1] Yang Chun;Yu Danfeng;Chang Chunyang;Zhu Gaoshang;Yuan Yuxia;Lai Zhizhen;Meng Jianbiao;Li Hailin(Department of Emergency Medicine,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China;Department of Critical Care Medicine,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)

机构地区：[1]浙江省立同德医院急诊医学科,杭州310012 [2]浙江省立同德医院重症医学科,杭州310012

出　　处：《中华危重病急救医学》2021年第10期1221-1225,共5页Chinese Critical Care Medicine

基　　金：浙江省中医药科技计划项目(2021ZA031)。

摘　　要：目的探讨长期口服β受体阻滞剂对脓毒症患者心肌损伤及预后的影响。方法采用回顾性研究方法,选择浙江省立同德医院急诊重症监护病房(EICU)和重症监护病房(ICU)2015年1月至2020年6月收治的患者,将符合脓毒性心肌损伤诊断的289例患者纳入分析,其中确诊前3个月内未服用过β受体阻滞剂的187例患者为非β-blocker组,确诊前每日口服β受体阻滞剂≥3个月的102例患者为β-blocker组。比较两组患者确诊时心率、平均动脉压(MAP),确诊24 h内心肌肌钙蛋白I(cTnI)、脑钠肽(BNP)、肌酸激酶同工酶(CK-MB)、血乳酸(Lac)、中心静脉血氧饱和度(ScvO_(2))、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、住院期间心脏超声指标〔左室射血分数(LVEF)、二尖瓣口舒张早期与晚期血流峰值流速比值(E/A)〕,以及血管活性药物使用率和28 d病死率。结果β-blocker组确诊时的心率显著低于非β-blocker组(次/min:107±8比110±7,P<0.01),确诊24 h内cTnI和BNP水平显著低于非β-blocker组〔cTnI(μg/L):0.191(0.220)比0.291(0.300),BNP(ng/L):627(133)比690(201),均P<0.05〕;而β-blocker组与非β-blocker组MAP、CK-MB、Lac、ScvO_(2)、SOFA评分、APACHEⅡ评分、LVEF、E/A、血管活性药物使用率及28 d病死率比较差异均无统计学意义〔MAP(mmHg,1 mmHg=0.133 kPa):70.6±3.9比69.9±3.8,CK-MB(μg/L):4.24(3.33)比4.32(3.13),Lac(mmol/L):3.50(1.80)比3.50(1.90),ScvO_(2):0.729±0.032比0.735±0.041,SOFA评分(分):7.74±2.34比7.25±2.23,APACHEⅡ评分(分):17.19±5.13比18.27±6.12,LVEF:0.567±0.058比0.557±0.051,E/A:0.71(0.20)比0.69(0.20),血管活性药物使用率:60.8%(62/102)比56.7%(106/187),28 d病死率:23.5%(24/102)比25.7%(48/187),均P>0.05〕。结论长期口服β受体阻滞剂有助于减轻脓毒症患者心肌损伤,但对疾病严重程度及预后无影响。Objective To investigate the effect of long-term oral administration ofβ-blocker on septic myocardial injury and prognosis.Methods A retrospective study was conducted.Patients who were admitted to the emergency intensive care unit(EICU)and intensive care unit(ICU)of Tongde Hospital of Zhejiang Province from January 2015 to June 2020 were enrolled.A total of 289 patients who met the criteria of myocardial injury induced by sepsis were included in the analysis.Among them,187 patients who had never takenβ-blocker within 3 months before diagnosis were divided in the non-β-blocker group,and 102 patients who tookβ-blocker daily for more than 3 months before diagnosis were in theβ-blocker group.The physiological and biochemical characteristics were compared between the two groups,including heart rate,mean arterial pressure(MAP)at the time of diagnosis,cardiac troponin I(cTnI),brain natriuretic peptide(BNP),MB isoenzyme of creatine kinase(CK-MB),blood lactic acid(Lac),central venous oxygen saturation(ScvO_(2)),sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score within 24 hours of diagnosis,left ventricular ejection fraction(LVEF),early and late mitral orifice diastolic peak flow velocity ratio(E/A),utilization rate of vasoactive drugs during hospitalization and 28-day mortality.Results The heart rate in theβ-blocker group at the time of diagnosis was significantly lower than that in the non-β-blocker group(bpm:107±8 vs.110±7,P<0.01),and the levels of cTnI and BNP within 24 hours of diagnosis were significantly lower than those in the non-β-blocker group[cTnI(μg/L):0.191(0.220)vs.0.291(0.300),BNP(ng/L):627(133)vs.690(201),both P<0.05].However,there were no significant differences in MAP,CK-MB,Lac,ScvO_(2),SOFA score,APACHEⅡscore,LVEF,E/A,vasoactive drug utilization rate,and 28-day mortality between theβ-blocker and non-β-blocker groups[MAP(mmHg,1 mmHg=0.133 kPa):70.6±3.9 vs.69.9±3.8,CK-MB(μg/L):4.24(3.33)vs.4.32(3.13),Lac(mmol/L):3.50(1.80)vs.3

关 键 词：Β受体阻滞剂 脓毒症 心肌损伤 预后 

分 类 号：R459.7[医药卫生—急诊医学]