艾司洛尔联合早期目标导向治疗对重度脓毒症患者心肌功能的保护作用分析

Analysis on the protective effect of esmolol combined with early goal-directed therapy on myocardial function in the patients with severe sepsis

目的分析艾司洛尔联合早期目标导向治疗对严重脓毒症患者心肌功能的保护作用。方法回顾性分析我院收治的严重脓毒症患者的临床资料,按随机、平衡、对照原则分别筛选艾司洛尔联合早期目标导向治疗的30例作为观察组,另筛选同期行早期目标导向治疗的30例作为对照组,对比两种治疗方案对患者血流动力学指标、心肌肌钙蛋白T(c Tn T)、B型利钠肽(BNP)、肿瘤坏死因子(TNF-α)、白细胞介素-1β(IL-1β)、血乳酸(Lac)、中心静脉血氧饱和度(ScvO_2)等指标水平的影响,并统计28 d生存率。结果治疗后,观察组Ea/Aa显著上升,HR显著下降,对照组仅HR显著下降,两组其他血流动力学指标组内及组间对比差异均无统计学意义(P>0.05);两组c Tn T、BNP、TNF-α、IL-1β等指标水平均显著下降且观察组低于对照组,组间及组内对比,其差异均有统计学意义;两组患者血Lac下降,ScvO_2上升,且观察组血Lac低于对照组,ScvO_2高于对照组,差异均有统计学意义(P<0.05);且观察组存活率略高于对照组,但差异无统计学意义(χ~2=0.480,P=0.488)。结论艾司洛尔联合早期目标导向治疗可使严重脓毒症患者获取一定的心肌保护。

Objective To analyze the protective effect of esmolol combined with early goal-directed therapy on myocardial function in patients with severe sepsis. Methods The clinical data of patients with severe sepsis who were treated in our hospital were retrospectively analyzed. According to the principles of randomization, balance and control, 30 cases receiving esmolol combined with early goal-directed therapy were selected as the observation group. The other 30 cases who were given early goal-directed therapy during the same period were selected as the control group. The effects of the two treatment regimens on the levels of hemodynamic indices, cTnT, BNP, TNF-α, IL-1β, Lac, central venous oxygen saturation（ScvO2） and other indices were compared, and 28-day survival rate was statistically analyzed. Results After treatment, Ea/Aa in the observation group was increased significantly, and HR was decreased significantly. Only HR was decreased significantly in the control group. There was no statistically significant difference within groups and be- tween the two groups in other hemodynamic indices （P〉0.05）; the levels of cTnT, BNP, TNF-α, and IL-1β in both groups were significantly decreased and the observation group was lower than the control group. The differences within groups and between groups were statistically significant; the serum Lac was decreased and ScvO2 was increased in both groups. The serum Lac in the observation group was lower than that in the control group, and ScvO2 was higher than that in the control group. There were statistically significant differences within groups and between groups （P〈0.05）; the survival rate in the observation group was slightly higher than that in the control group, but the difference was not statistically significant（x^2=0.480, P=0.488）. Conclusion Esmolol combined with early goal-directed therapy may benefit myocardial protection in patients with severe sepsis.