美托洛尔在治疗脓毒性休克患者中的应用效果

Application effect of Metoprolol in the treatment of patients with septic shock

目的探讨美托洛尔在治疗脓毒性休克患者中的应用效果。方法选取2017年7月1日~2019年3月31日阳江市中医医院、广州市珠江医院、阳春市人民医院收治的40例脓毒性休克患者作为研究对象。采用随机数字表法将其分为常规治疗组和美托洛尔组,每组各20例。常规治疗组患者接受常规治疗,美托洛尔组患者在常规治疗基础上应用美托洛尔治疗。比较两组患者治疗前后的心率、平均动脉压、中心静脉压(CVP)、中心静脉氧饱和度(ScvO2)、尿量;比较两组患者治疗后不同时间(治疗后4、8、16、24、36、48、72、96 h)的心指数(CI)和外周血管阻力指数(SVRI);比较两组患者的心力衰竭发生情况、28 d病死情况。结果治疗前,两组患者的心率、平均动脉压、CVP、ScvO2、尿量、CI、SVRI比较,差异无统计学意义(P>0.05)。两组患者治疗前后的平均动脉压比较,差异无统计学意义(P>0.05)。美托洛尔组患者治疗后的心率慢于治疗前,差异有统计学意义(P<0.05);常规治疗组患者治疗前后的心率比较,差异无统计学意义(P>0.05)。两组患者治疗后的CVP、ScvO2、尿量均高于本组治疗前,差异有统计学意义(P<0.05)。治疗后,美托洛尔组患者的心率慢于常规治疗组,CVP、ScvO2、尿量高于常规治疗组,差异均有统计学意义(P<0.05);两组患者的平均动脉压比较,差异无统计学意义(P>0.05);两组患者治疗后4、8、16、24、36、48、72、96 h的CI以及治疗后8、16、24、36、48、72、96 h的SVRI比较,差异无统计学意义(P>0.05);治疗后4 h,美托洛尔组患者的SVRI低于常规治疗组,差异有统计学意义(P<0.05)。美托洛尔组患者的心力衰竭发生率(40.0%)、28 d病死率(10.0%)均低于常规治疗组(75.0%、40.0%),差异有统计学意义(P<0.05)。结论脓毒血症在充分液体复苏、血流动力学稳定的基础上应用美托洛尔能有效降低心率,能够降低心力衰竭发生率及28 d死亡率,值得推广。

Objective To investigate the effect of Metoprolol in the treatment of patients with septic shock.Methods From July 1,2017 to March 31,2019,40 patients with septic shock admitted to Yangjiang Traditional Chinese Medicine Hospital,Zhujiang Hospital in Guangzhou City and Yangchun People′s Hospital were selected as research objects,the patients were divided into conventional treatment group and Metoprolol group by random number table method,with 20 cases in each group.Patients in the conventional treatment group received routine treatment,while patients in the Metoprolol group received Metoprolol treatment on the basis of routine treatment.The heart rate,mean arterial pressure,central venous pressure(CVP),central venous oxygen saturation(ScvO2)and urine volume before and after treatment were compared between the two groups.The cardiac index(CI)and peripheral vascular resistance index(SVRI)of the two groups were compared at different time after treatment(4,8,16,24,36,48,72,96 h after treatment).The incidence of heart failure and death in 28 d were compared between the two groups.Results Before treatment,there were no significant difference in heart rate,mean arterial pressure,CVP,ScvO2,urine volume,CI and SVRI between the two groups(P>0.05).There was no significant difference in the mean arterial pressure between the two groups before and after treatment(P>0.05).The heart rate of Metoprolol group after treatment was slower than that before treatment,the difference was statistically significant(P<0.05).There was no significant difference in heart rate before and after treatment in conventional treatment group(P>0.05).After treatment,the CVP,ScvO2 and urine volume of the two groups of patients were higher than before treatment,the differences were statistically significant(P<0.05).After treatment,the heart rate of Metoprolol group was slower than that of the conventional treatment group,and the CVP,ScvO2 and urine volume were higher than those of the conventional treatment group,the differences were statistically significant(P<0.05).There was no significant difference in the mean arterial pressure between the two groups(P>0.05).There were no significant difference between the two groups in CI(4,8,16,24,36,48,72,96 h after treatment)and SVRI(8,16,24,36,48,72,96 h after treatment)(P>0.05).SVRI of Metoprolol group was lower than that of conventional treatment group 4 h after treatment,the difference was statistically significant(P<0.05).The incidence of heart failure(40.0%)and 28 d mortality(10.0%)in Metoprolol group were lower than those in conventional treatment group(75.0%and 40.0%),the differences were statistically significant(P<0.05).Conclusion The application of Metoprolol to sepsis on the basis of full fluid resuscitation and stable hemodynamics can effectively reduce heart rate,heart failure rate and 28 d mortality,which is worthy of promotion.