艾司洛尔联合乌司他丁在空腔脏器穿孔致脓毒性休克患者术后心肌保护的临床观察

Clinical Observation of Postoperative Myocardial Protection by Esmolol Combined with Ulinastatin in Patients with Septic Shock Caused by Hollow Viscera Perforation

目的探讨艾司洛尔联合乌司他丁在空腔脏器穿孔致脓毒性休克患者术后的心肌保护。方法选择2016年2月至2018年2月因空腔脏器穿孔致脓毒性休克术后入住ICU的52例患者,根据治疗方案随机分为研究组26例与对照组26例,对照组给予常规治疗方案,研究组在常规方案上加用艾司洛尔及乌司他丁治疗。观察两组患者的炎性介质(TNF-α、IL-1β)、CK同功酶质量定量(CK-MB)、超敏肌钙蛋白T(hs-cTNT)、钠尿肽(PROBNP)、心律失常发生率、血管活性药物用量、入住ICU时间。结果治疗后不同时间段,研究组患者的炎性介质指标、心肌损害指标、心律失常发生率及入住ICU时间均低于常规治疗组,差异有统计学意义(P<0. 05),血管活性药物用量差异无统计学意义(P>0. 05)。结论艾司洛尔联合乌司他丁能有效降低脓毒性休克患者的心肌损,能降低心律失常的发生率,对循环无明显影响。

Objective To investigate the postoperative myocardial protection by esmolol combined with ulinastatin in patients with septic shock caused by hollow viscera perforation. Methods A total of 52 patients admitted to ICU after septic shock due to hollow viscera perforation from February 2016 to February 2018 were selected,then they were randomly divided into a study group of 26 cases and a control group of 26 cases according to the treatment regimen.The inflammatory mediators(TNF-α、IL-1β),the quality of CK isoenzyme(CK-MB),hypersensitive troponin T(hs-cTNT),natriuretic peptide(PROBNP),the incidence of arrhythmia,the dosage of vasoactive drugs and the duration of ICU stay were observed in the two groups. Results At different periods after treatment,the inflammatory mediators,myocardial damage index,incidence of arrhythmia and the duration of ICU stay of the study group were all lower than those of the conventional treatment group,with statistically significant differences( P <0.05),while there was no statistically significant difference in vasoactive drug dosage( P >0.05). Conclusion Esmolol combined with ulinastatin can effectively reduce the myocardial damage in patients with septic shock,reduce the incidence of arrhythmia,and have no obvious effect on circulation.