| 沈雯雯,徐前程,钱言,等.β1受体阻滞剂对早期脓毒性休克病人心肌损伤及预后的影响[J].安徽医药,2019,23(4):760-763. |
| β1受体阻滞剂对早期脓毒性休克病人心肌损伤及预后的影响 |
| Effects of β1-blockers on myocardial injury and prognosis in patients with early septic shock |
| 投稿时间：2017-11-07 |
| DOI： |
| 中文关键词: 休克,脓毒性 美托洛尔 受体,肾上腺素能β1 乳酸 降钙素基因相关肽 肌钙蛋白I 预后 |
| 英文关键词: Shock,septic Metoprolol Receptors,adrenergic,beta-1 Lactic acid Calcitonin gene-related peptide Troponin I Prognosis |
| 基金项目: |
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| 中文摘要: |
| 目的 观察β1受体阻滞剂对早期脓毒性休克病人心肌损伤及预后的影响,评价治疗的安全性及探讨其影响病人预后的可能机制。方法 采用回顾性对照研究方法,选择2013年1月至2015年12月芜湖市第二人民医院重症医学科(ICU)54例确诊为脓毒性休克且临床资料完整的病人。根据是否使用β1受体阻滞剂美托洛尔分为治疗组28例和对照组26例,记录两组病人治疗后72 h循环指标、血清降钙素原(PCT)、肌钙蛋白I(CTnI)、血乳酸(Lac)水平的变化及机械通气时间、住ICU时间和28 d病死率等。所有病人再根据28 d的生存结局分为存活组和死亡组,logistic回归分析影响病人预后的危险因素。结果72 h后治疗组心室率(HR)(90.6±8.9)次/分低于对照组(118.4±23.1)次/分(t=5.916,P＜0.001),两组病人心指数(CI)、平均动脉压(MAP)、血管活性药物的用量、72 h液体平衡量以及血清降钙素原(PCT)、血乳酸(Lac)水平、机械通气时间和病死率均差异无统计学意义(均P＞0.05),治疗组住ICU时间、肌钙蛋白I(CTnI)水平低于对照组(均P＜0.05)；死亡组急性生理和慢性健康评分(APACHEⅡ评分)、CTnI、Lac水平高于存活组(P＜0.05),死亡组β1受体阻滞剂使用率(31.6%)低于存活组(62.9%)(P＜0.05)；logistic回归分析显示,CTnI＞1.21 μg/L、APACHEⅡ评分＞19.5分是早期脓毒性休克病人预后的危险因素,β1受体阻滞剂是影响病人预后的保护性因素(P＜0.05)。结论 β1受体阻滞剂可降低脓毒性休克早期病人的心率和心肌氧耗,减轻心肌损伤,且对血流动力学影响小,可以缩短住ICU时间,可能是此类病人预后的潜在保护因素。 |
| 英文摘要: |
| Objective To observe the effects of β1-blockers on myocardial injury and prognosis in patients with early septic shock,to evaluate the safety of treatment and to explore the possible mechanism of its effect on prognosis.Methods Clinical data of 54 cases with sepsis shock admitted to intensive care unit (ICU) of Wuhu No.2 People's Hospital from January 2013 to December 2015 were retrospectively studied.The patients were assigned into treatment group (n＝28) and control group (n＝26) according to whether using β1-blockers Metoprolol or not.The hemodynamic parameters,the tests of procalcitonin (PCT),cardiac troponin I (CTnI) and lactic acid (Lac) were recorded at 72 hours after the treatment,and the mechanical ventilation time,length of ICU stay and 28-day mortality were also analyzed.All the patients were then assigned into survival group and death group according to the survival outcome of 28 days.Multivariate logistic regression analysis was used to analyze the prognostic factors.Results Contrasted to control group,the heart rate (HR) of treatment group decreased significantly [(90.6±8.9) bpm vs. (118.4±23.1) bpm,t=5.916,P＜0.001],while the cardiac index (CI),mean arterial pressure (MAP),the dosage of vasoactive agent and 72 h liquid balance amount did not show any statistical significance between the two groups (P＞0.05).There were also no statistical differences in PCT,Lac levels,mechanical ventilation time and mortality between the two groups (P＞0.05),while length of ICU stay in treatment group was significantly shorter and CTnI level was lower than the control group;the differences were statistically significant (both P＜0.05).Acute physiological and chronic health score (APACHEⅡ score),CTnI and Lac levels in the death group were significantly higher than those in survival group (P＜0.05).The use rate of β1-blockers in death group (31.6%) was lower than that in survival group (62.9%,P＜0.05).Logistic regression analysis confirmed that CTnI＞1.21 μg/L and APACHEⅡ score＞19.5 were the risk factors,whereas β1-blockers was the protective factor for the prognosis of patients with sepsis (P＜0.05).Conclusions β1-blockers could reduce heart rate and myocardial oxygen consumption,decrease the myocardial injury in patients with early septic shock,while has little effect on hemodynamics and can shorten length of ICU stay.β1-blockers may be a potential protective factor in the prognosis of patients with septic shock. |
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