Clinical trial of esmolol in the treatment of patients with sepsis-related myocardial damage
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 injection 2.0 x 105 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·kg-1·h-1,and then the dose was adjusted every 5 min,the maximum dose was not more than 0.2 mg·kg-1·h-1,and was injected intravenously for 24 h.The clinical efficacy,acute physiological and chronic health status score Ⅱ(APACHE Ⅱ),24 h lactic acid clearance,left ventricular ejection fraction(LVEF),myocardial injury indexes[cardiac troponin Ⅰ(cTn Ⅰ),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 APACHE Ⅱ scores 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(1 213.58±176.42)and(1 584.01±203.59)pg·mL-1;cTn Ⅰ levels 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)cmH2O;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-1,and the differences were statistically significant(all P＜0.05).Bradycardia was the main adverse drug reaction in the treatment group,and no adverse drug reaction occurred in the control group.The total incidence rates of adverse drug reactions in treatment group and control group were 1.89％and 0 without statistical significance(P＞0.05).Conclusion Esmolol injection has good short-term efficacy in the treatment of sepsis-related myocardial damage,which can improve hemodynamics,reduce myocardial damage and promote the recovery of cardiac function.
esmolol injectionsepsis-related myocardial damageshort-term efficacyhemodynamicsmyocardial function
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