脓毒症心肌抑制患者静脉泵入米力农联合艾司洛尔的短期疗效

Combination therapy with milrinone and esmolol in patients with septic myocardial depression

目的:探讨米力农联合艾司洛尔对脓毒症心肌抑制患者血流动力学及心功能的影响。方法:选择2010年10月至2014年10月首都医科大学附属北京世纪坛医院重症医学科确诊为脓毒症患者,使用脉搏指示连续心排血量(PICCO)血流动力学检测评价血流动力学参数,将心脏指数CI<2.2L/(min·m2)需应用正性肌力药物的的74例患者纳入本研究,并按照随机数字表法分为常规治疗组及米力农联合爱络组两组,每组37例。常规治疗组为A组(多巴酚丁胺组),B组(米力农联合艾司洛尔组)。治疗期间比较两组PiCCO及超声相关参数,并检测心肌酶(CK、CK-MB、MYO、cTnI)及ProBNP水平。结果:(1)与A组相比,B组治疗后3dCI、GEF明显增高。(2)与A组相比,B组治疗后3d左心室舒张早期/舒张晚期最大血流比值(E/A)、舒张期右室内径(RVD)差异均有显著性。(3)与A相比较,B组治疗后3dCK-MB、cTnI、ProB-NP均下降更为显著。结论:联合应用米力农及艾司洛尔,可使脓毒症心肌抑制患者心率减慢,射血分数增加,降低肺动脉压,减轻心肌损害,具有改善心脏功能及优化血流动力的作用。

Objective To evaluate the effect of combination therapy with milrinone and esmolol on hemodynamics and cardiac function in patients with septic myocardial depression. Methods From October 2010 to October 2013, after the hemodynamics and cardiac function were evaluated by pulse indicator continuous cardiac output （PICCO）, 74 sepsispatients withCI 〈 2.2 L/min· m^2 after fluid resuscitation were enrolled in the study and were divided into group A with intravenous injection of dobutamine hydrochloride, and group B with intravenous injection of milrinone and esmolol, with 37 cases in each group. The patients＇ PICCO indicators, echocardiography and cardiac biomarker （CK, CK-MB, MYO, cTnI and ProBNP） in two groups were compared before and after 3-day treatment. Results （1） CI and GEF were significantly increased in group B after 3-day treatment when compared with those in group A. （2） Compared with those in group A, early diastolic mitral flow velocity/end diastolic mitral velocity （E/A） and right ventricular diastolic diameter （RVD） in group B had statistical significance. （3） CK-MB, cTnI and ProBNP decreased significantly in group B when compared with those in group A. Conclusion Combination therapy with milrinone and esmolol can increase cardiac ejection function, slow down the heart rate, reduce the heart blood and vascular preload, lessen the injury of myocardial and improve heart function.