艾司洛尔辅助早期目标导向治疗对重度脓毒症患者心肌功能及预后的影响

Effects of Esmolol-assisted Early Goal-directed Therapy on Myocardial Function and Prognosis of Patients with Severe Sepsis

目的:探究艾司洛尔辅助早期目标导向治疗(early goal-directed therapy,EGDT)对重度脓毒症患者心肌功能及预后的影响。方法:选取2019年2月至2020年12月南昌市第一医院收治的脓毒症患者82例,按照随机数表法分为对照组和观察组各41例。对照组进行EGDT治疗,观察组在EGDT治疗的基础上辅以艾司洛尔进行治疗。比较两组患者治疗后24 h临床疗效、治疗前后心功能指标,炎症指标及治疗的不良反应情况。结果:治疗后观察组总有效率为95.12%,对照组总有效率为75.61%,观察组明显高于对照组(P<0.05);治疗后两组心功能指标中血气指标间隔与侧壁二尖瓣环舒张早期峰值流速/舒张晚期峰值流速(Ea/Aa)均有所上升,且观察组Ea/Aa明显高于对照组(P<0.05);治疗后两组心肌相关指标肌钙蛋白(cTnI)、N-末端脑钠肽前体(NT-proBNP)均有所下降,且观察组明显低于对照组(P<0.05);治疗后两组患者炎症指标白细胞介素(IL-1β)、肿瘤坏死因子(TNF-α)水平明显下降,且观察组明显优于对照组(P<0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论:艾司洛尔辅助早期目标导向治疗可明显改善了重度脓毒症患者的心肌功能及血流动力学机制相关的预后。

Objective:To explore the effects of esmolol-assisted early goal-directed therapy(early goal-directed therapy,EGDT)on myocardial function and prognosis of patients with severe sepsis.Methods:A total of 82 patients with sepsis admitted to the Nanchang First Hospital were enrolled between February 2019 and December 2020.They were divided into control group and observation group according to random number table method,41 cases in each group.The control group was treated with EGDT,while observation group was additionally treated with esmolol.The clinical curative effect at 24 h after treatment,cardiac function indexes and inflammation indexes before and after treatment,and adverse reactions were compared between the two groups.Results:After treatment,the total response rate in observation group was significantly higher than that in control group(95.12%vs 75.61%)(P<0.05).After treatment,the interval of blood gas index and early peak diastolic velocity/end peak diastolic velocity(Ea/Aa)of mitral annulus in both groups was increased,which was significantly higher in observation group than control group(P<0.05).After treatment,levels of cardiac troponin(cTnl)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in both groups were decreased,which were significantly lower in observation group than control group(P<0.05).After treatment,levels of interleukin(IL-1β)and tumor necrosis factor(TNF-α)in both groups were significantly decreased,which were significantly better in observation group than control group(P<0.05).There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).Conclusion:Esmolol-assisted EGDT can significantly improved myocardial function and prognosis related to mechanism of blood flow with severe sepsis.