艾司洛尔治疗脓毒症休克的临床效果及其对血清内皮细胞特异性分子1、缺氧诱导因子1α水平的影响

Clinical effect of esmolol for the treatment of septic shock and its influence on serum endothelial cell specific molecule 1 and hypoxia inducible factor 1αlevels

目的探讨艾司洛尔治疗脓毒症休克的临床效果,以及其对患者血清内皮细胞特异性分子1(ESM-1)、缺氧诱导因子1α(HIF-1α)水平的影响。方法将92例脓毒症休克患者随机分为研究组和对照组,各46例。对所有患者进行液体复苏治疗,同时对照组患者持续24 h静脉泵入等渗溶液,研究组持续24 h静脉泵入艾司洛尔注射液。比较两组患者治疗前后平均动脉压(MAP)、氧合指数、心率、血乳酸水平、血清ESM-1水平、血清HIF-1α水平、急性生理与慢性健康状况评价Ⅱ(APACHEⅡ)评分、序贯器官衰竭评估(SOFA)评分,以及机械通气时间、住院时间和ICU入住时间。结果治疗12 h、24 h、48 h后,两组患者的MAP、氧合指数均较治疗前上升,心率、血乳酸水平均较治疗前下降,且研究组上述指标均优于对照组(均P<0.05)。治疗后两组患者的APACHEⅡ评分、SOFA评分、血清ESM-1水平、血清HIF-1α水平均治疗前下降,且研究组上述指标均低于对照组(均P<0.05)。研究组患者的机械通气时间、住院时间、ICU入住时间均短于对照组(均P<0.05)。结论在体液复苏治疗的基础上使用艾司洛尔治疗脓毒症休克患者疗效显著,可有效控制患者心率,降低血清炎症因子ESM-1、HIF-1α水平,适合临床应用推广。

Objective To investigate the clinical effect of esmolol for the treatment of septic shock and its influence on serum endothelial cell specific molecule 1(ESM-1)and hypoxia inducible factor 1α(HIF-1α)levels.Methods A total of 92 patients with septic shock were randomly assigned to research group or control group,with 46 cases in each group.All patients were treated with fluid resuscitation;simultaneously,patients in the control group received intravenous pumping of isoosmotic solution for 24 hours continuously,and the research group received intravenous pumping of esmolol injection for 24 hours continuously.The pre-and post-treatment mean arterial pressure(MAP),oxygenation index,heart rate,and blood lactic acid level,serum ESM-1 and HIF-1αlevels,and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Sequential Organ Failure Assessment(SOFA)score,as well as mechanical ventilation duration,length of hospital stay and length of ICU stay in patients were compared between the two groups.Results After 12,24,and 48 hours of treatment,patients in both groups obtained elevated MAP and oxygenation index,and decreased heart rate and blood lactic acid level as compared with before treatment,and the research group exhibited superior indices as above as compared with the control group(all P<0.05).After treatment,patients in the two groups acquired decreased scores of APACHEⅡand SOFA,and serum ESM-1 and HIF-1αlevels as compared with before treatment,and the research group interpreted lower indices as above as compared with the control group(all P<0.05).The mechanical ventilation duration,length of hospital stay and ICU stay were shorter in the research group than in the control group(all P<0.05).Conclusion On the basis of fluid resuscitation therapy,employing esmolol for the treatment of septic shock patients exerts a significant efficacy,and can effectively control patients′heart rate,decrease serum levels of inflammatory factors in terms of ESM-1 and HIF-1α,which is suitable for clinical application and promotion.