艾司洛尔对老年人感染性休克心肌损伤的保护作用

Protective effect of esmolol on myocardial injury of senile septic shock

目的探讨艾司洛尔对老年人感染性休克心肌损伤是否具有保护作用。方法选取我科60岁以上感染性休克,经标准化治疗后心率仍大于100次/min患者36例。根据其有无冠心病或心房纤颤等心脏基础疾病随机分为3组,A组:既往无冠心病及心房纤颤等基础疾病组;B组:既往有冠心病并接受β受体阻滞剂治疗组;C组:既往有心房纤颤并长期服用β受体阻滞剂控制心室率组。分别给予艾司洛尔进行干预。在给药前及给药后心率达标2h内对患者心脏功能进行评价。结果给予艾司洛尔干预并达标后,患者APACHE-Ⅱ评分、MODS评分下降,CK-MB、cTnI及BNP下降,中心静脉血氧饱和度改善、全血乳酸下降、尿量增加,与给药前相比,有统计学意义(P<0.05);心脏超声检查提示除A组射血分数(EF)稍下降外,其余两组射血分数非但未见下降,反而上升,C组上升明显(P<0.01),给药前后患者舒张功能无明显变化(P>0.05)。结论艾司洛尔对老年人感染性休克患者心肌损伤具有保护作用,特别是伴有冠心病以及心房纤颤等心脏基础疾病者保护作用更突出。

Objective The aim of the present study was to investigate the effect of esmolol on myocardial injury of senile septic shock. Methods Thirty-six cases more than 60 years old of septic shock,whose rate is still greater than 100 beats/min after standardized treatment,were selected. According to heart basic diseases such as coronary heart disease or atrial fibrillation,they were randomly divided into three groups. Group A：without basic diseases such as coronary heart disease and atrial fibrillation group;Group B：history of coronary heart disease（CHD） and accept a beta blocker treatment group;Group C：previous have atrial fibrillation and long-term administration of beta blockers to control ventricular rate group. Esmolol Were given to intervene. Cardiac function was evaluated before and after administration of the drug within 2 hours. Results After administration of esmolol intervention and up to standard,on one hand,patients＇ APACHE-II scores and MODS scores decreased,including CK-MB,cTnI and BNP declining. On the other hand,central venous oxygen saturation improved and blood lactate decreased,urine volume increased.Compared with before administration,it was statistically significant（P〈0.05）;Cardiac ultrasound examination suggests that the ejection fraction of group B and C instead of fell,fall but rose,in addition to group A. Group C increased significantly（P〈0.01）. Before and after treatment in patients with diastolic function did not change significantly（P〉0.05）. Conclusion Esmolol has an protective effect on myocardial injury of septic shock infections in the elderly,especially with heart foundation disease such as coronary heart disease and atrial fibrillation.