摘要
目的探讨肾上腺素能β1受体阻滞剂对重度脓毒症患者血流动力学的影响。方法以2012年6至12月于南昌大学第四附属医院重症医学科住院的16例机械通气的重度脓毒症患者为研究对象,其中男14例,女2例;年龄48~67岁,平均(58±6)岁;其中4例多发伤,6例急性重症胰腺炎,6例因消化道肿瘤近期刚行手术根治术治疗。所有研究对象通过中心静脉注射肾上腺素能B,受体阻滞剂艾司洛尔使心率下降20%,用多功能监护仪和与肺动脉漂浮导管连接的血流动力学监测仪,监测心率、收缩压、舒张压、心输出量、心脏指数、中心静脉压、肺动脉嵌顿压、肺循环阻力指数、体循环阻力指数和每搏输出量指数,用药前10min、用药后3h行动脉血气检查监测动脉二氧化碳分压(PaCO2)、动脉血乳酸浓度及上腔静脉氧饱和度(ScvO2)、上腔静脉二氧化碳分压(PcvO2),计算静动脉二氧化碳分压差(Pcv—aCO2)。结果艾司洛尔给药后3h与给药前10min比较,患者心率和心脏指数均明显下降[(91+13)比(114±15)次/min和(3.44-0.7)比(4.24-0.8)L·min-1·m2](均P〈0.05),而收缩压、舒张压、中心静脉压、肺动脉嵌顿压、肺循环阻力指数、体循环阻力指数和每搏输出量指数均无明显变化[(100±13)比(108±14)mmHg(1mmHg=0.133kPa)、(62±7)比(64±6)mmHg、(11.8±2.5)比(12.1±2.4)mmHg、(13±5)比(14±4)mmHg、(201-4-72)比(179.4-95)dyn·s/(cm5·m2)、(1360±520)比(1366±538)dyn·s/(cm5·m2)、(40±9)比(38±6)ml/(次·m2)](均P〉0.05);Scv02、乳酸、Pcv—aC02也无明显变化[(72.8±5.3)%比(70.1±4.0)%、(2.11±0.13)比(2.31±0.23)mmol/L、(3.9±1.0)比(4.5±0.8)mmHg](均P〉0.05)。结论肾上腺素能B,受体阻滞剂可通过减慢重度脓毒症患者心率而减少心输出量,但对心脏功能和全身组织灌注无明显影响。
Objective To explorethe effects of adrenergic beta-1 antagonists on hemodynamics of severe septic patients. Methods A total of 16 severe septic patients underwent mechanical ventilation from June 2012 to December 2012 at Fourth Affiliated Hospital of Nanchang University. There were 14 males and 2 females with a mean age of (58 ±6 ) years (range: 48 -67 years ). Among them, there were multiple trauma ( n = 4 ), acute severe pancreatitis ( n = 6) and recent tumorectomy for gastrointestinal cancer ( n = 6). The adrenergic beta-1 antagonist esmolol was injected through central venous catheter to reduce heart rate by 20% from baseline. Various indices ( heart rate, systolic blood pressure, diastolic blood pressure, cardiac output, cardiac index, central venous pressure, pulmonary artery wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke volume index) were monitored by a muhifunctional and hemodynamic monitor connected to pulmonary artery catheter. And other indices of arterial pressure of carbon dioxide (PaCO2 ), lactate (Lae) concentration, superior vena cava oxygen saturation (ScvO2 ), superior vena cava carbon dioxide pressure (PcvO2 ) and central venous-to-arterial carbon dioxide tension difference ( Pcv-aCO2 ) were measured by a blood-gas-analyzer before 10 minutes and after 3 hours of dosing. Results Heart rate and cardiac index decreased significantly at 3 hours post-dosing compared with that at pre-dosing ( (91 ± 13 ) vs ( 114 ± 15) beats per minute, (3.4 ±0.7) vs (4. 2 ±0. 8) L min-Im-2, P 〈 0.05) , but systolic blood pressure, diastolic blood pressure, central venous pressure, pulmonary wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke index showed no significant changes ( ( 100 ± 13 ) vs ( 108 ± 14 ) mm Hg ( 1 mm Hg = 0. 133 kPa), (62_±7) vs (64 ±6) mm Hg, (11.8 ±2.5) vs (12.1 ±2.4) mm Hg, (13 ±5) vs (14± 4) mmHg, (201 ±72) vs (179 _±95) dyn ~ s/(em5 ~ m2), (1360 _±520) vs (1366 ±538) dyn s/ (cm5 m2), (40_±9) vs (38 ±6) ml/(beat ± m2), all P〉0.05). ScvO2, Lae and Pev-aCO2 also showed no significant change ((72.8 ±5.3)% vs (70.1 ±4.0)%, (2.11±0.13) vs (2.31 ±0.23) mmol/L, (3.9±1.0) vs (4.5±0.8) mmHg , allP〉0.05). Conclusion Adrenergic beta-1 antagonist may reduce cardiac output in proportion to the percentage decreases in heart rate in severe septic patients without adverse effects upon cardiac function and systemic perfusion.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2013年第16期1243-1246,共4页
National Medical Journal of China