艾司洛尔对脓毒症病人外周血淋巴细胞分泌细胞因子水平及心功能的影响

Influence of Esmolol on cytokines by peripheral blood lymphocyte and ventricular function in patients with sepsis

目的探讨艾司洛尔对脓毒症病人淋巴细胞分泌细胞因子及心功能的影响。方法选择住院的脓毒症病人116例,按随机数字表法分为治疗组(58例)和对照组(58例),对照组给予常规治疗,治疗组在常规治疗的基础上给予艾司洛尔,首剂500 mg静脉注射,之后按0.05 mg·kg^(-1)·min^(-1)的维持剂量静脉滴注。测定治疗前、治疗12、24、48 h后的血浆肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)和白细胞介素-6(IL-6)水平。心脏超声测量治疗前、治疗12、24、48 h后的心率(HR)、左室射血分数(LVEF)、左室舒张末前后径(LVDD)、二尖瓣环舒张期早期峰值速度(Ea)与舒张晚期峰值速度(Aa)比值(Ea/Aa)。结果与对照组相比,治疗组在治疗后TNF-α、IL-1β和IL-6都明显下降,三种细胞因子在治疗后12、24、48 h均低于对照组(P<0.05)。治疗组在治疗后HR明显下降,各时间点的HR低于对照组(P<0.05);Ea/Aa比值则明显上升,各时间点的Ea/Aa比值均显著高于对照组(P<0.05)。28 d后治疗组病死率(31.03%)低于对照组(67.24%),差异有统计学意义(P<0.01)。结论艾司洛尔能降低脓毒症病人的炎性细胞因子的表达,改善病人左心室舒张功能。

Objective To probe the influence of Esmolol on cytokines by peripheral blood lymphocyte and ventricular function in pa-tients with sepsis. Methods A total of 116 hospitalized patients with sepsis were chosen and randomly divided into treating group （58 cases） and control group（58 cases）. Patients in control group were given conventional treatment,while patients in treating group were given Esmolol intravenous injection （first-dose 500 mg,then 0. 05 mg·kg-1·min-1 ） maintenance dose） on the base of conventional treatment. Serum TNF-a,IL-lp and IL-6 were tested and the change of HR,LVEF,LVDD and Ea/Aa were measured by echocardio-graphy before treatment and 12,24,48 hours after treatment. Results Compared with the control group,levels of TNF -α,IL- 1β and IL- 6 in treatment group decreased after treatment,and was all lower than those of controls at 12,24,48 hours after treatment （P〈0. 0 5 ） . HR in treatment group obviously decreased after treatment,and all was lower than those of controls at 12,24,48 hours after treatment （P 〈 0. 05 ） . Ea/Aa in treatment group obviously rose after treatment, and all was higher than those of controls at 12 ,24 ,48 hours after treatment （P〈0. 05）. Mortality rate of treatment group 28 days later （31.03% ） was lower than that of controls （67. 24% ） with sta-tistically significant difference （ P 〈 0. 01） . Conclusion Esmolol can decrease the expression of inflammatory cytokines of sepsis pa-tients and improve left ventricular diastolic function.