艾司洛尔控制开颅手术苏醒期脑过度灌注的效果

目的 通过监测脑血流速度、颈静脉球部血氧饱和度(SjvO2)、血压、心率(HR)和不良反应发生率等,综合评价艾司洛尔用于控制开颅手术苏醒期患者脑过度灌注的效果.方法 选择择期在全身麻醉下行开颅肿瘤切除术的患者,随机分为艾司洛尔组(E组,20例)和对照组(C组,20例).E组患者从拔管即刻起给予艾司洛尔0.6 mg·kg1·h-1静脉持续滴注15 min C组患者从拔管即刻起给予0.9%氯化钠溶液静脉持续滴注.分别监测两组患者术前、术后拔管即刻及拔管后15、30、45、60 min时的大脑中动脉平均血流速度(MCAVm)、SivO2平均动脉压(MAP)及HR,并记录不良反应发生例数.结果 E组术后15和30 min的MCA Vm、sjvO2及HR均显著低于C组(P值均<0.01),术后15 Min的MAP显著低于C组(P<0.05).无一例患者发生与艾司洛尔相关的药物不良反应.结论 艾司洛尔是控制术后脑过度灌注的理想药物.     

Esmolol,an ultrashort-acting,selective β1-adrenoceptor antagonist: pharmacodynamic and pharmacokinetic properties

The effects of esmolol at different rates of infusion (100, 250 and 500 g·kg^–1 BW·min^–1) were compared with -adrenoceptor occupancy (₁ and ₂, estimated by a subtype selective radioreceptor assay) and plasma concentrations of esmolol and its acid metabolite were measured by HPLC. Up to a rate of infusion of esmolol of 500 g·kg^–1 BW·min^–1 there was a maximal ₁-receptor occupancy of 84.7% while ₂-receptor occupancy was below the detection limit; confirming the ₁ selectivity of esmolol. Exercise-induced increases in heart rate and systolic blood pressure were reduced by esmolol in a dose-dependent manner. The estimated EC₅₀ values of rate of infusion for the reduction in heart rate and systolic blood pressure during exercise were 113 and 134 g·kg^–1 BW · min^–1, respectively. Additionally, heart rate and systolic blood pressure were reduced moderately at rest. Because of the short elimination half-life of esmolol caused by the rapid hydrolysis to its acid metabolite, 45 min after end of infusion high plasma concentrations of the metabolite (maximally 80 g·ml^–1) but no esmolol were detectable. Since no in vivo effects have been observed, despite the presence of high plasma concentrations of the metabolite, the metabolite did not participate in the observed effects up to an infusion rate of esmolol of 500 g·kg^–1 BW·min^–1. The plasma concentrations of antagonist detected by radioreceptor assay and plasma concentrations of esmolol detected by HPLC showed a good correlation (r=0.97). Since the cardiovascular effects, determined before and 45 min after termination of infusion of esmolol were similar, it can be concluded that the observed effects on heart rate and systolic blood pressure are exclusively mediated by esmolol.Dedicated to Dr. P.Rajagopal, Kuantan Specialist Hospital, Kuantan, Malaysia     

艾司洛尔治疗小儿腭裂手术中心动过速30例

目的：观察艾司洛尔在小儿腭裂手术中出现心动过速时的治疗效果。方法：30例腭裂手术病人，在手术中静脉滴注艾司洛尔10～30mg。结果：30例手术病人的心率都有不同程度的下降。结论：艾司洛尔在小儿腭裂手术中对心动过速具有显著疗效。     

硝酸甘油注射液复合盐酸艾司洛尔注射液用于妊高征心衰的控制

目的寻找更有效控制妊高征产妇心衰的药物，为妊高征产妇心衰麻醉手术处理提供新方法。方法随机抽取广州市重症孕产妇救治中心妊高征心衰紧急剖宫产的产妇100例，采用双盲法随机分为A、B两组，每组50例。两组均进入手术室后先控制心衰后麻醉；A组硝酸甘油注射液5mg／ml以0．9％的氯化钠注射液稀释成10ml以0．05mg／kg快速单次静脉注射，同时复合盐酸艾司洛尔注射液1mg／kg快速单次静脉注射；B组单纯硝酸甘油注射液5mg／ml以0．9％的氯化钠注射液稀释10ml以0．05mg／kg快速单次静脉注射；4分钟、8分钟后观察各指标及相关症状并评判其有效性。结果A组产妇比B组控制心衰效果明显更好，用药后4分钟及8分钟A组SBP／DBP、HR、SPO2、RR、CVP、ECG等指标较B组明显改善俨〈0．05），端坐呼吸者可平卧接受气管插管麻醉。结论硝酸甘油注射液复合盐酸艾司洛尔注射液用于妊高征心衰比使用单纯硝酸甘油注射液更好，值得推广应用，硝酸甘油注射液与盐酸艾司洛尔注射液复合使用确能药效互补完全控制好心衰。     

乌拉地尔复合艾司洛尔控制性降压在高血压患者脊柱手术中的应用

目的评估在经后路椎体间植骨、椎弓根钉内固定术中,高血压患者脊柱手术中乌拉地尔复合艾司洛尔控制性降压的可行性。方法 60例经后路椎体间植骨、椎弓根钉内固定术高血压患者随机分为两组,即U组(单纯乌拉地尔组)、U-E组(乌拉地尔复合艾司洛尔组),各3O例。手术开始时即行控制性降压,U组:先静脉注射盐酸乌拉地尔0.4mg/kg,此后持续泵注乌拉地尔,维持初始量20～25μg/(kg·min);U-E组:先静脉注射盐酸乌拉地尔0.4mg/kg、艾司洛尔10mg,此后持续泵注盐酸乌拉地尔20～25μg/(kg·min),同时持续泵注艾司洛尔,速率20～30μg/(kg·min)。使平均动脉压(MAP)降至目标血压(MAP降至基础血压的70%)。此后根据血压情况调整用药速度,至手术主要步骤操作完毕、术野止血完毕后停止降压。记录开始降压前即刻(T0)、降压5min(T1)、降压10min(T2)、降压30min(T3)、降压60min(T4)、停止降压后15min(T5)6个时间点血压(SBP、DBP、MAP)、心率(HR)、中心静脉压(CVP)的变化及晶胶体输入量、尿量、出血量和输血量、手术时间,并进行血气分析。结果两组患者MAP的下降均显著低于降压前(P<0.01);降压期间,U组心率在T1、T2、T3时增快,与T0比较有差异有统计学意义;U-E组的心率显著低于U组(P<0.05)。两组术中出血量、尿量、输血量比价,差异无统计学意义(P>0.05)。结论乌拉地尔复合艾司洛尔控制性降压应用于高血压患者脊柱手术安全、有效,可控性良好。     

术前急性扩容血液稀释联合控制性降压用于脑膜瘤手术麻醉的临床研究

目的：观察急性扩容血液稀释联合控制性降压对脑膜瘤手术的血液保护效果。方法择期32例美国麻醉医师协会（American Society of Anesthesiologists,ASA）I～I级脑膜瘤手术患者,随机分成对照组和试验组(n=16)。常规麻醉诱导后,试验组快速输入羟乙基淀粉20mL/kg。术中静脉用硝酸甘油和艾司洛尔实施控制性降压,维持平均动脉压（mean arterial pressure,MAP）>65mmHg。记录麻醉诱导前(T1),血液扩容稀释后15min(T2),手术开始后60 min(T3)及手术结束(T4)时2组患者心率（heart rate,HR）、MAP、中心静脉压（central venous pressure,CVP）、血红蛋白（hemoglobin,Hb）和血球压积（hematocrit,Hct）。结果试验组T2时MAP显著高于对照组,术中T3时MAP显著低于对照组（P<0.05）。试验组中有9例患者接受输血,出血量显著低于对照组（P<0.05）;对照组中有15例患者术中接受了异体输血,输血量显著高于试验组（P<0.05）。结论急性扩容血液稀释联合控制性降压可以安全应用于脑膜瘤手术的麻醉,减少失血量。     

The influence of esmolol on septic shock and sepsis: A meta-analysis of randomized controlled studies

Background

Esmolol may have some potential in treating septic shock and sepsis. However, the results remain controversial. We conduct a systematic review and meta-analysis to explore the efficacy of esmolol in patients with septic shock and sepsis.

艾司洛尔联合米力农对严重脓毒症患者心功能炎性因子及预后的影响

目的观察艾司洛尔联合米力农对严重脓毒症患者的治疗效果及探讨其可能作用机制。方法将90例符合严重脓毒症诊断标准且经早期目标导向治疗（ EGDT ）后心率≥95次／min的患者,随机分为对照组（ C组）、米力农组（ M组）和艾司洛尔联合米力农组（ ME组）。 C组按照脓毒症指南常规治疗。 M组在C组常规治疗基础上给予米力农持续静脉泵入,负荷剂量为30μg／kg,然后以0.375～0.5μg／（kg? min）维持。 ME组应用艾司洛尔持续静脉泵入,将患者心率控制在75～94次／min,余治疗方案同M组。采用脉搏指示连续心排血量监测（ PiCCO）检测患者心脏指数（CI）及每搏指数（SVI）等心功能指标,同时连续观察治疗前及治疗后12、24、48、72、96 h平均动脉压（MAP）、中心静脉压（CVP）、心率（HR）、氧合指数（PaO2／FiO2）和血乳酸（Lac）,并检测TNF－α、IL－6、HMGB－1、CK－MB、cTnI及BNP水平。结果治疗前各组MAP、CVP、HR、PaO2／FiO2及Lac比较差异无统计学意义,治疗后各组MAP、CVP及PaO2／FiO2比较差异无统计学意义,治疗后12 h ME组HR显著低于C组和M组,治疗后48 h M组、ME组Lac显著低于C组。治疗前各组CI及SVI比较差异无统计学意义,治疗后12 h M组、ME组CI及SVI显著高于C组。治疗前各组血浆TNF－α、IL－6、HMGB－1、CK－MB、cTnI及BNP水平比较差异无统计学意义,治疗后24 h ME组血浆TNF－α、IL－6、HMGB－1、CK－MB、cTnI及BNP水平显著低于C组和M组。 ME组28天生存率和96小时心率达标率显著高于C组和M组。结论艾司洛尔联合米力农可显著改善严重脓毒症患者心功能及28天生存率,同时显著降低心率并抑制全身炎症反应。     

Safety and efficacy of intravenous esmolol before prospective electrocardiogram-triggered high-pitch spiral acquisition for computed tomography coronary angiography

Background In order to acquire a high quality image with a low radiation dose, prospective electrocardiogram （ECG）-triggered computed tomography coronary angiography （CTCA） requires a stable heart rate （HR） 〈 65 beats/min. Esmolol has the advantage of reduc-ing HR. The objective of this article is to assess the value of intravenous esmolol treatment before prospective ECG-tr/ggered high-pitch spiral acquisition for CTCA. Methods From March 2013 to June 2013, 313 patients underwent prospective ECG-triggered CTCA. Two hundred and thirty two of them received esmolol before angiography. We retrospectively analyzed clinical characteristics, esmolol dose, radiation exposure dose, and the change in HR and blood pressure in these 232 patients. Results A total of 232 patients with a HR 〉 65 beats/rain before CTCA examination received intravenous esmolol treatment （mean dose of 57.26±15.39 rag）, The mean initial HR （HR1）, slowest HR （HR2）, and the HR 30 min after HR2 （HR3） were 75.06± 5.59, 60.75 ±4.00, and 75.54 ± 5.96 beats/min, respectively （HR1 vs. HR2, P 〈 0.0001; HRI vs. HR3, P = 0.377）. The mean time from esmolol administration to HR2 was 24.25 ± 4.97 s and the mean effective radiation dose was 2.28 ± 0.02 mSv. Conclusions HR could be rapidly controlled at an optimum level with intravenous esmolol before prospective ECG-triggered high-pitch spiral acquisition for CTCA. Consequently, the patients received a very low radiation dose.     

Early reversal cardiac with esmolol in hypertensive rats: The role of subcellular organelle phenotype

BackgroundOur group has previously shown that short-term treatment (48 h) with esmolol reduces left ventricular hypertrophy (LVH) in spontaneously hypertensive rats (SHRs). However, we do not know the mechanism that explain this effect. The aim of this study was to assess the role that the subcellular organelle phenotype plays in early cardiac reverse after short-term treatment with esmolol.Methods14-Month-old male SHRs were randomly assigned to receive esmolol (300 μg/kg/min) (SHR-E) or vehicle (SHR). Age-matched male Wistar-Kyoto rats (WKY) served as controls. After 48 h of treatment, an ultrastructural analysis of heart tissue (left ventricle) was performed. We studied cardiomyocyte ultrastructural remodeling of subcellular organelles by electronic microcopy in all groups.ResultsSHR group showed significant morphometric and stereological changes in mitochondria and subcellular organelles (cytoplasm and nucleus, myofibril structure, mitochondria structure, Z-Disk, intercalated disk, T-system and cystern), and also changes in the extracellular matrix (collagen) with respect to WKY group. Esmolol significantly improved the morphology and stereology mitochondrial, reduced the organelle phenotype abnormalities but no produced changes in the extracellular matrix with respect to SHR group. Interesantly, parameters of mitochondria (regularity factor, ellipsoidal form factor and density of volume), and all parameters of subcellular organelles returned to the normality in SHR-E.ConclusionOur results show that left ventricular hypertrophy reversal after short-term treatment with esmolol is associated with reversal of subcellular organelle phenotype.