艾司洛尔治疗脓毒症相关心肌损害患者的临床研究  

Clinical trial of esmolol in the treatment of patients with sepsis-related myocardial damage

作　　者：孙瑜婧[1] SUN Yu-jing(Emergency Department,ZZhongshan Hospital Affiliated to Xiamen University,Xiamen 361004,Fujian Province,China)

机构地区：[1]厦门大学附属中山医院急诊部,福建厦门361004

出　　处：《中国临床药理学杂志》2024年第19期2811-2816,共6页The Chinese Journal of Clinical Pharmacology

摘　　要：目的观察艾司洛尔注射剂治疗脓毒症相关心肌损害的短期疗效,及其对血流动力学的影响。方法将脓毒症相关心肌损害患者按队列法分为试验组和对照组。对照组给予注射用乌司他丁2.0×10^(5)U,tid,共治疗7 d;试验组在对照组治疗的基础上,给予注射用盐酸艾司洛尔治疗,初始剂量为0.05 mg·kg^(-1)·h^(-1),而后每5 min调整一次用药剂量,最大剂量需不超过0.2 mg·kg^(-1)·h^(-1),静脉泵入24 h。比较2组患者的临床疗效、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)变化、24 h乳酸清除率、左心室射血分数(LVEF)、心肌损伤指标[心肌肌钙蛋白Ⅰ(cTnⅠ)、氨基末端B型脑钠肽原(NT-proBNP)等]及血流动力学指标(心率、中心静脉压)、氧化应激指标[丙二醛(MDA)、超氧化物歧化酶(SOD)],并评价安全性。结果试验组和对照组分别纳入53例。治疗后,试验组和对照组的总有效率分别为88.68%(47例/53例)和69.81%(37例/53例),在统计学上差异有统计学意义(P<0.05)。治疗后,试验组和对照组的APACHEⅡ评分分别为(17.65±3.02)和(19.31±2.78)分,24 h乳酸清除率分别为(56.91±4.17)%和(53.02±4.35)%,LVEF分别为(56.09±4.10)%和(54.17±3.08)%,NT-proBNP水平分别为(1213.58±176.42)和(1584.01±203.59)pg·mL^(-1),cTnⅠ水平分别为(0.32±0.06)和(0.51±0.10)μg·L^(-1),心率分别为(89.67±6.71)和(94.13±6.28)beat·min^(-1),中心静脉压分别为(11.71±1.13)和(10.64±1.37)cm H_(2)O,血清MDA水平分别为(4.17±0.82)和(5.01±0.95)μmol·L^(-1),血清SOD水平分别为(68.78±5.81)和(63.53±6.07)U·mL^(-1),试验组的上述指标与对照组比较,在统计学上差异均有统计学意义(均P<0.05)。试验组的药物不良反应主要有心动过缓,对照组治疗期间未出现药物不良反应。试验组和对照组的总药物不良反应发生率分别为1.89%和0,在统计学上差异无统计学意义(P>0.05)。结论艾司洛尔注射剂治疗脓毒症相关心肌损害的短期疗效Objective To observe the short-term efficacy of esmolol injection in the treatment of sepsis-related myocardial damage and its influence on hemodynamics.Methods Patients with sepsis-related myocardial damage were divided into treatment group and control group by cohort method.Control group was given ulinastatin for injection2.0×10^(5)U,tid,on the basis of basic treatment for 7 days;the treatment group was given esmolol hydrochloride on the basis of the control group,the initial dose was 0.05 mg·mg·kg^(-1)·h^(-1),and then the dose was adjusted every 5 min,the maximum dose was not more than 0.2 mg·mg·kg^(-1)·h^(-1),and was injected intravenously for 24 h.The clinical efficacy,acute physiological and chronic health status scoreⅡ(APACHEⅡ),24 h lactic acid clearance,left ventricular ejection fraction(LVEF),myocardial injury indexes[cardiac troponinⅠ(cTnⅠ),amino terminal B-type brain natriuretic peptide(NT-proBNP)],hemodynamic indexes[heart rate,central venous pressure],oxidative stress indexes[malondialdehyde(MDA),superoxide dismutase(SOD)]were compared between the two groups,and the safety was evaluated.Results Fifty-three cases were included in the treatment group and the control group.After treatment,the total effective rates of the treatment group and the control group were 88.68%(47 cases/53 cases)and 69.81%(37 cases/53 cases),and the difference was statistically significant(P<0.05).After treatment,the APACHEⅡscores of the treatment group and the control group were(17.65±3.02)and(19.31±2.78)points;the 24 h lactic acid clearance rates were(56.91±4.17)%and(53.02±4.35)%;LVEF values were(56.09±4.10)%and(54.17±3.08)%,NT-proBNP levels were(1213.58±176.42)and(1584.01±203.59)pg·mL^(-1);cTnⅠlevels were(0.32±0.06)and(0.51±0.10)μg·L^(-1),heart rate values were(89.67±6.71)and(94.13±6.28)beats·min^(-1);central venous pressure values were(11.71±1.13)and(10.64±1.37)cmH_(2)O;serum MDA levels were(4.17±0.82)and(5.01±0.95)μmol·L^(-1);serum SOD levels were(68.78±5.81)and(63.53±6.07)U·mL^(

关 键 词：艾司洛尔注射剂 脓毒症相关心肌损害 短期疗效 血流动力学 心肌功能 

分 类 号：R972[医药卫生—药品]