艾司洛尔辅助液体复苏治疗脓毒症休克的效果及对NLRP2、ENO1及PCT水平的影响

Effect of esmolol-assisted fluid resuscitation in the treatment of septic shock and the influence on NOD-like receptor protein 2,α-enolase 1,and procalcitonin levels

目的探究艾司洛尔辅助液体复苏治疗脓毒症休克的效果及对患者NOD样受体家族蛋白2(NLRP2)、α-烯醇化酶(ENO1)及降钙素原(PCT)水平的影响。方法选取2020年1月至2022年1月西安国际医学中心医院收治的120例脓毒症休克患者纳入研究,按随机数表法分为对照组和观察组,每组60例。两组患者均接受规范脓毒症休克治疗,对照组患者接受中心静脉压(CVP)指导下早期目标导向(EDGT)液体复苏,观察组患者则联合静脉泵入艾司洛尔,持续24 h;比较两组患者治疗前(入组时)、治疗后(入组后24 h)的乳酸水平、乳酸清除率,6 h内复苏率及治疗前后的B型尿钠肽(BNP)、肌钙蛋白I(cTnI)、磷酸激酶同工酶(CK-MB)、序贯器官衰竭评分(SOFA)、急性生理与慢性健康(APACHEⅡ)、NLRP2、ENO1及PCT水平。结果治疗后,观察组患者的乳酸水平为(0.56±0.08)mmol/L,明显低于对照组的(1.13±0.15)mmol/L,乳酸清除率、6 h内复苏率分别为(89.18±14.75)%、86.67%,明显高于对照组的(80.41±10.18)%、71.67%,差异均有统计学意义(P<0.05);治疗后,观察组患者的BNP、cTnI、CK-MB水平分别为(101.28±12.80)pg/mL、(86.79±11.84)ng/L、(1.03±0.02)ng/mL,明显低于对照组的(128.52±15.19)pg/mL、(104.43±14.27)ng/L、(1.07±0.08)ng/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的SOFA评分、APACHEⅡ评分别为(4.13±0.31)分、(10.72±2.01)分,明显低于对照组的(4.48±0.5)分、(12.29±1.48)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的NLRP2、ENO1、PCT水平分别为(419.65±102.73)pg/mL、(345.83±60.16)ng/L、(9.03±1.94)pg/mL,明显低于对照组的(541.65±99.28)pg/mL、(426.20±67.85)ng/L、(14.75±4.15)pg/mL,差异均有统计学意义(P<0.05)。结论艾司洛尔辅助液体复苏治疗脓毒症休克的效果好,其在保护患者心肌功能的同时能改善体内炎症因子水平。

Objective To investigate the effect of esmolol-assisted fluid resuscitation in the treatment of septic shock and the influence on NOD-like receptor protein 2(NLRP2),α-enolase 1(ENO1),and procalcitonin(PCT)levels.Methods A total of 120 patients with septic shock admitted to Xi'an International Medical Center Hospital from January 2020 to January 2022 were included in the study.According to the random number table,the patients were divided into a control group and an observation group,with 60 patients in each group.Both groups underwent standard treatments for septic shock.The patients in the control group received early goal-directed therapy(EGDT)guided by central venous pressure(CVP),and the patients in the observation group were treated with intravenous injection of esmolol for 24 h based on the treatment of control group.The lactate levels before treatment(at admission)and after treatment(24 h after admission),lactate clearance rate,resuscitation rate within 6 h,the levels of B-type natriuretic peptide(BNP),cardiac troponin I(cTnI)and creatine kinase-MB(CK-MB),the Sequential Organ Failure Assessment(SOFA)scores,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)scores,and the levels of NLRP2,ENO1,and PCT before and after treatment were compared between the two groups.Results After treatment,the lactate level in the observation group was(0.56±0.08)mmol/L,which was significantly lower than(1.13±0.15)mmol/L in the control group,while the lactate clearance rate and resuscitation rate within 6 h were(89.18±14.75)% and 86.67%,significantly higher than(80.41±10.18)% and 71.67% in the control group(P<0.05).After treatment,the levels of BNP,cTnI,and CK-MB in the observation group were(101.28±12.80)pg/mL,(86.79±11.84)ng/L,and(1.03±0.02)ng/mL,which were significantly lower than(128.52±15.19)pg/mL,(104.43±14.27)ng/L,and(1.07±0.08)ng/mL in the control group(P<0.05).After treatment,the score of SOFA and APACHEⅡ in the observation group were(4.13±0.31)points and(10.72±2.01)points,which were significantly lower than(4.48±0.5)points and(12.29±1.48)points in the control group(P<0.05).After treatment,the levels of NLRP2,ENO1,and PCT in the observation group were(419.65±102.73)pg/mL,(345.83±60.16)ng/L,and(9.03±1.94)pg/mL,which were significantly lower than(541.65±99.28)pg/mL,(426.20±67.85)ng/L,and(14.75±4.15)pg/mL in the control group(P<0.05).Conclusion Esmolol-assisted fluid resuscitation has a goof effective in the treatment of septic shock,which can protect myocardial function and improve the levels of inflammatory factors.