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去甲肾上腺素联合艾司洛尔对脓毒症休克患者心肌功能及乳酸清除率的影响

Effect of norepinephrine combined with esmolol on myocardial function and lactate clearance rate in patients with septic shock

    摘要
  • 摘要:
      目的  探讨去甲肾上腺素联合艾司洛尔对脓毒症休克患者心肌功能和乳酸清除率的影响。
      方法  100例脓毒症休克患者依据入院顺序分为对照组(n=48)与观察组(n=52)。所有患者均给予规范抗感染和液体复苏治疗, 对照组在此基础上采用去甲肾上腺素治疗，观察组在对照组基础上联合艾司洛尔治疗。比较2组机械通气时间、重症加强护理病房(ICU)住院时间、6 h内复苏成功率以及治疗前后心肌功能、血乳酸浓度和乳酸清除率、组织灌注情况、序贯器官衰竭估计(SOFA)评分、急性生理与慢性健康(APACHE-Ⅱ)评分。
      结果  观察组机械通气时间、ICU住院时间显著短于对照组, 6 h内复苏成功率和治疗7 d后乳酸清除率显著高于对照组(P < 0.05)。治疗前, 2组B型尿钠肽(BNP)、肌钙蛋白T(cTnT)及磷酸肌酸同工酶(CK-MB)、尿量、中心静脉血氧饱和度(ScvO2)、SOFA评分、APACHEⅡ评分比较无显著差异(P>0.05); 治疗后, 2组BNP、cTnT及CK-MB、SOFA评分、APACHEⅡ评分均较治疗前显著下降(P < 0.05), 观察组上述指标显著低于对照组(P < 0.05), 尿量、ScvO2均较治疗前显著上升(P < 0.05), 观察组尿量、ScvO2显著高于对照组(P < 0.05)。
      结论  去甲肾上腺素联合艾司洛尔能够提高脓毒症休克的疗效，保护心肌功能，提高乳酸清除率，减轻患者组织缺氧程度。

     

    Abstract:
      Objective  To investigate the effect of norepinephrine combined with esmolol on myocardial function and lactate clearance rate in patients with septic shock.
      Methods  Totally 100 septic shock patients were divided into control group (n=48) and observation group (n=52) according to the order of hospital admission. All the patients were treated with standard anti-infection and fluid resuscitation. The control group was treated with norepinephrine on this basis, while the observation group was treated with esmolol on the basis of the control group. The mechanical ventilation time, hospital stay in intensive care unit (ICU), recovery success rate within 6 hours, myocardial function, blood lactate concentration and lactate clearance rate, tissue perfusion, sequential organ failure estimation (SOFA) score, acute physiology and chronic health (APACHE Ⅱ) score were compared between the two groups.
      Results  The duration of mechanical ventilation and hospital stay in ICU in the observation group were significantly shorter than those in the control group, while the success rate of resuscitation within 6 hours and lactate clearance rate after 7 days of treatment were significantly higher than those in the control group (P < 0.05). Before treatment, there were no significant differences in B-type natriuretic peptide (BNP), troponin T (cTnT), creatine phosphate isoenzyme (CK-MB), urine volume, central venous oxygen saturation (ScvO2), SOFA score and APACHE Ⅱ score between the two groups (P>0.05). After treatment, BNP, cTnT and CK-MB, SOFA score and APACHE II score in both groups decreased significantly (P < 0.05), and the above indexes in the observation group were significantly lower than those in the control group (P < 0.05), while urine volume and ScvO2 were significantly higher than those before treatment (P < 0.05), and urine volume and ScvO2 in the observation group were significantly higher than those in the control group (P < 0.05).
      Conclusion  Norepinephrine combined with esmolol can improve the curative effect of patients with septic shock, protect myocardial function, improve lactate clearance rate and reduce the degree of hypoxia in patients′ tissues.

     

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