首页|艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响

艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响

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目的:探讨艾司洛尔联合去甲肾上腺素对脓毒症休克患者心功能及预后的影响.方法:回顾性分析2020年12月至2023年1 月该院收治的 74 例脓毒症休克患者的临床资料,根据治疗方案不同将其分为对照组与研究组各 37 例.两组均予以常规抗感染、抗炎、液体复苏等治疗,在此基础上对照组采用重酒石酸去甲肾上腺素注射液治疗,研究组在对照组基础上加用盐酸艾司洛尔注射液治疗.比较两组治疗前后血流动力学指标[心率、平均动脉压(MAP)]水平、病情危重度[急性生理与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)、序贯器官衰竭评估量表(SOFA)]评分、心功能指标[每搏指数(SVI)、心脏指数(CI)]水平、心肌损伤标志物[高敏肌钙蛋白T(hs-cTnT)、N末端B型脑钠肽前体(NT-proBNP)]水平、血清炎性因子[高迁移率族蛋白B1(HMGB1)、白细胞介素-6(IL-6)]水平、血乳酸水平、不良反应发生率及 28 d生存率.结果:治疗后研究组心率,APACHE Ⅱ、SOFA评分,血清hs-cTnT、NT-proBNP、HMGB1、IL-6、血乳酸水平均低于对照组,SVI、CI水平均高于对照组,差异有统计学意义(P<0.05);治疗 6 h后,两组MAP水平均高于治疗前,但组间比较差异无统计学意义(P>0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05);研究组 28 d生存率为 78.39%(29/37),对照组 28 d生存率为 67.57%(25/37),差异无统计学意义(P>0.05).结论:艾司洛尔联合去甲肾上腺素治疗脓毒症休克患者可促进心率恢复正常,且不影响血压水平,并减轻心肌损伤,提高心功能,降低血清炎性因子和血乳酸水平,从而加快病情缓解,效果优于单用去甲肾上腺素.
Effects of Esmolol combined with Norepinephrine on cardiac function and prognosis in patients with septic shock
Objective:To investigate effects of Esmolol combined with Norepinephrine on cardiac function and prognosis in patients with septic shock.Methods:The clinical data of 74 patients with septic shock admitted to this hospital from December 2020 to January 2023 were retrospectively analyzed.According to different treatment options,they were divided into control group and study group,37 cases in each.Both groups were treated with routine anti-infection,anti-inflammation and fluid resuscitation.On this basis,the control group was treated with Norepinephrine bitartrate injection,while the study group was treated with Esmolol hydrochloride injection on the basis of that of the control group.The levels of hemodynamic indexes[heart rate,mean arterial pressure(MAP)],the severity of illness[acute physiology and chronic health evaluation II(APACHE II),sequential organ failure assessment(SOFA)]score,the cardiac function indexes[stroke index(SVI),cardiac index(CI)]levels,the myocardial injury markers[high-sensitivity troponin T(hs-cTnT),N-terminal pro-brain natriuretic peptide(NT-proBNP)]levels,the the serum inflammatory factors[high mobility group protein B1(HMGB1),interleukin-6(IL-6)]levels,the blood lactic acid level,the incidence of adverse reactions,and the 28-day survival rate were compared between the two groups before and after the treatment.Results:After the treatment,the heart rate,the APACHE II and SOFA scores,the serum hs-cTnT,NT-proBNP,HMGB1,IL-6 levels and the blood lactate levels in the study group were lower than those in the control group,the levels of SVI and CI were higher than those in the control group,and the differences were statistically significant(P 0.05).The 28-day survival rate of the study group was 78.39%(29/37),and the 28-day survival rate of the control group was 67.57%(25/37).After 6 hours of treatment,the MAP levels in both groups were higher than those before the treatment,but there was no statistically significant difference between the groups(P>0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).The 28-day survival rate of the study group was 78.39%(29/37),that of the control group was 67.57%(25/37),and the difference was not statistically significant(P>0.05).Conclusions:Esmolol combined with Norepinephrine in the treatment of the patients with septic shock can promote the recovery of heart rate,and does not affect the levels of blood pressure,and reduce the myocardial injury,improve the cardiac function,and reduce the serum inflammatory factors and blood lactic acid levels,thereby accelerating the remission of the disease.Moreover,it is superior to single Norepinephrine treatment.

EsmololNoradrenalineSepsis shockCardiac functionInflammatory indicatorPrognosis

程智、刘相位、郭艳珂、王鋆

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郑州大学第五附属医院全科医学科,河南 郑州 450052

艾司洛尔 去甲肾上腺素 脓毒症休克 心功能 炎性指标 预后

2024

中国民康医学
中国社会工作协会

中国民康医学

影响因子:0.649
ISSN:1672-0369
年,卷(期):2024.36(3)
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