艾司洛尔改善脓毒性休克心功能的临床研究

目的探讨盐酸艾司洛尔注射液对脓毒性休克患者心功能的改善作用。方法选取2015年2月—2016年12月项城市第一人民医院收治的脓毒性休克患者70例,按随机数字表法将患者分为对照组和治疗组,每组各35例。对照组给予常规干预治疗,包括补液、营养支持、抗感染、纠正水、电解质酸碱平衡、呼吸循环支持等。治疗组在对照组基础液体复苏24 h后静脉滴注盐酸艾司洛尔注射液,初始剂量为50 mg/h,根据患者的血压、心率情况调整使用剂量,治疗24 h。观察两组的临床疗效,比较两组的血液灌注指标、血流动力学指标、心肌标志物和心肌组织代谢指标的情况。结果治疗后,对照组和治疗组的总有效率分别为71.48%、91.43%,两组比较差异有统计学意义(P0.05)。治疗后,两组平均动脉压(MAP)和心率(HR)均降低,同组治疗前后比较差异有统计学意义(P0.05);且治疗组HR的下降程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组心排血指数(CI)均降低,而外周血管阻力指数(SVRI)和全心舒张期末容积指数(GEDVI)均升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组这些观察指标的改善程度明显优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组乳酸(Lac)水平均显著降低,而肌钙蛋白I(c Tn I)水平均显著升高,同组治疗前后比较差异有统计学意义(P0.05);且治疗组c Tn I水平明显高于对照组,两组比较差异具有统计学意义(P0.05)。结论盐酸艾司洛尔注射液可显著改善脓毒性休克心功能,调节血液灌注指标、血流动力学指标、心肌标志物和组织代谢指标,安全性较好,具有一定的临床推广应用价值。

Clinical study on esmolol in improvement of septic shock cardiac function

Objective To investigate the effect of Esmolol Hydrochloride Injection in improvement of septic shock cardiac function. Methods Patients (70 cases) with septic shock in The First People''s Hospital of Xiangcheng from February 2015 to December 2016 were randomly divided into control and treatment groups, and each group had 35 cases. Patients in the control group were given routine intervention treatment, including fluid replacement, nutritional support, anti-infection, correct water and electrolyte acid-base balance, respiration support, and circulation support. Patients in the treatment group were iv administered with Esmolol Hydrochloride Injection after 24 h of fluid resuscitation on the basis of the control group. The initial dose was 50 mg/h, and the dosage was adjusted according to the patient''s blood pressure and heart rate, and were treated for 24 h. After treatment, the clinical efficacies were evaluated, and blood perfusion indexes, hemodynamic indexes, myocardial marker, and myocardial tissue metabolic indexes in two groups were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 71.48% and 91.43%, respectively, and there was difference between two groups (P < 0.05). After treatment, MAP and HR in two groups were decreased, and the difference was statistically significant in the same group (P < 0.05). And the HR in the treatment group was significantly lower than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the CI in two groups was decreased, but SVRI and GEDVI in two groups were increased, and the difference was statistically significant in the same group (P < 0.05). And the observational indexes in the treatment group were significantly better than those in the control group, with significant difference between two groups (P < 0.05). After treatment, the Lac levels in two groups were significantly decreased, but the cTnI levels in two groups were significantly increased, and the difference was statistically significant in the same group (P < 0.05). And the cTnI level in the treatment group was significantly higher than those in the control group, with significant difference between two groups (P < 0.05). Conclusion Esmolol Hydrochloride Injection can improve septic shock cardiac function, regulate blood perfusion index, hemodynamic index, myocardial marke, and myocardial tissue metabolic index, with good safety, which has a certain clinical application value.