Clinical study on the cardioprotection of esmolol in patients with septic shock

doi:10.3877/cma.j.issn.1674-6880.2019.01.003

Abstract

Abstract:

Objective

To investigate the cardioprotective effect of esmolol on septic shock patients.

Methods

Forty-four patients with septic shock in Tongde Hospital of Zhejiang Province were randomly divided into the control group (n = 22) and treatment group (n = 22). The treatment group received intravenous infusion of esmolol on the basis of routine treatment, while the control group was continuously pumped with isoosmotic NaCl solution. The general data, heart rate, central venous pressure (CVP), mean arterial pressure (MAP), stroke volume index (SVI), cardiac index, global end diastolic volume index (GEDVI), left ventricular ejection fraction (LVEF), mitral orifice diastolic peak flow velocity ratio (E/A), cardiac troponin I (cTnI), brain natriuretic peptide, blood lactate and central venous blood oxygen saturation (ScvO₂) of the two groups were recorded at 0, 24, 48, 72 and 96 h after enrollment, and the mortality rate in 28 days was compared.

Results

There were significant differences in the heart rate, cardiac index, GEDVI, E/A, cTnI and brain natriuretic peptide between the two groups (F = 58.045, 11.102, 7.132, 7.136, 2.970, 3.006; all P < 0.05). Further comparison showed that the heart rate and cardiac index in the treatment group at 24, 48, 72 and 96 h were significantly lower than those in the control group at the same time point and in the treatment group at 0 h (all P < 0.05). The levels of GEDVI and E/A in the treatment group at 48, 72 and 96 h were significantly higher than those in the control group at the same time point and in the treatment group at 0 h (all P < 0.05). The expressions of cTnI and brain natriuretic peptide in the treatment group were significantly lower than those in the control group at 48, 72 and 96 h (all P < 0.05). The expressions of cTnI and brain natriuretic peptide at 72 and 96 h were significantly lower than those at 0 h in the treatment group (all P < 0.05). There was no significant difference in the mortality rate between the two groups in 28 days (7/22 vs. 5/22, χ² = 0.458, P = 0.498).

Conclusion

Esmolol can alleviate myocardial injury and improve myocardial diastolic function in septic shock patients; it has no effect on circulation, tissue perfusion and oxygen metabolism, and has no significant change in prognosis.

Key words: Esmolol, Shock, septic, Myocardial injury, Cardiac protection

Chun Yang, Cheng Wang, Ting Chen, Jinpeng Wang, Yinyan Weng, Zhizhen Lai, Jianbiao Meng, Hailin Li. Clinical study on the cardioprotection of esmolol in patients with septic shock[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(01): 15-19.

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References 21

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组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	SOFA评分（分）
对照组	22	60 ± 11	12/10	18 ± 5	8±4
治疗组	22	56 ± 14	9/13	19 ± 5	9±3
t/χ²值		1.181	0.820	1.043	0.922
P值		0.244	0.365	0.303	0.362

组别	例数	年龄（岁）	性别比（例，男/女）	APACHEⅡ评分（分）	SOFA评分（分）
对照组	22	60 ± 11	12/10	18 ± 5	8±4
治疗组	22	56 ± 14	9/13	19 ± 5	9±3
t/χ²值		1.181	0.820	1.043	0.922
P值		0.244	0.365	0.303	0.362

组别	时间点	例数	心率（次/min）	CVP（mmHg）	MAP（mmHg）	SVI（mL/m²）	心脏指数（L·min^-1 · m^-2）	GEDVI（mL/m²）	LVEF（%）	E/A
对照组	0 h	22	114 ± 18	10.2 ± 1.4	69.0 ± 2.2	35.1 ± 6.9	4.0 ± 1.1	657 ± 53	47.0 ± 4.8	0.71 ± 0.23
	24 h	22	112 ± 13	11.0 ± 2.7	69.2 ± 3.2	36.2 ± 7.1	4.0 ± 0.9	662 ± 53	47.1 ± 5.3	0.70 ± 0.16
	48 h	22	109 ± 8	10.6 ± 2.5	69.8 ± 4.1	35.8 ± 2.6	3.9 ± 0.3	670 ± 36	47.1 ± 5.9	0.71 ± 0.20
	72 h	22	109 ± 12	11.3 ± 2.9	72.6 ± 8.2	36.1 ± 4.7	3.8 ± 0.6	667 ± 59	48.5 ± 6.5	0.75 ± 0.24
	96 h	22	105 ± 12^a	11.5 ± 3.1	71.3 ± 8.5	35.3 ± 5.0	3.8 ± 0.5	672 ± 63	49.6 ± 6.4	0.80 ± 0.22
治疗组	0 h	22	112 ± 13	10.9 ± 1.2	70.6 ± 4.4	35.8 ± 6.8	4.0 ± 1.0	661 ± 49	48.9 ± 6.0	0.69 ± 0.25
	24 h	22	91 ± 4^ab	10.8 ± 2.9	71.8 ± 5.7	37.2 ± 5.3	3.4 ± 0.5^ab	668 ± 51	48.2 ± 6.0	0.76 ± 0.16
	48 h	22	90 ± 4^ab	11.5 ± 2.5	70.0 ± 8.8	36.9 ± 4.2	3.3 ± 0.4^ab	698 ± 51^ab	47.8 ± 5.5	0.85 ± 0.19^ab
	72 h	22	87 ± 4^ab	11.8 ± 3.4	72.4 ± 6.5	37.3 ± 4.8	3.2 ± 0.4^ab	729 ± 45^ab	48.7 ± 5.1	0.92 ± 0.21^ab
	96 h	22	87 ± 7^ab	11.3 ± 2.6	71.9 ± 7.0	38.5 ± 5.4	3.4 ± 0.6^ab	738 ± 40^ab	50.5 ± 6.1	1.03 ± 0.19^ab
F值			58.045	0.732	1.120	1.263	11.102	7.132	0.689	7.136
P值			< 0.001	0.397	0.296	0.268	0.002	0.011	0.411	0.011

组别	时间点	例数	心率（次/min）	CVP（mmHg）	MAP（mmHg）	SVI（mL/m²）	心脏指数（L·min^-1 · m^-2）	GEDVI（mL/m²）	LVEF（%）	E/A
对照组	0 h	22	114 ± 18	10.2 ± 1.4	69.0 ± 2.2	35.1 ± 6.9	4.0 ± 1.1	657 ± 53	47.0 ± 4.8	0.71 ± 0.23
	24 h	22	112 ± 13	11.0 ± 2.7	69.2 ± 3.2	36.2 ± 7.1	4.0 ± 0.9	662 ± 53	47.1 ± 5.3	0.70 ± 0.16
	48 h	22	109 ± 8	10.6 ± 2.5	69.8 ± 4.1	35.8 ± 2.6	3.9 ± 0.3	670 ± 36	47.1 ± 5.9	0.71 ± 0.20
	72 h	22	109 ± 12	11.3 ± 2.9	72.6 ± 8.2	36.1 ± 4.7	3.8 ± 0.6	667 ± 59	48.5 ± 6.5	0.75 ± 0.24
	96 h	22	105 ± 12^a	11.5 ± 3.1	71.3 ± 8.5	35.3 ± 5.0	3.8 ± 0.5	672 ± 63	49.6 ± 6.4	0.80 ± 0.22
治疗组	0 h	22	112 ± 13	10.9 ± 1.2	70.6 ± 4.4	35.8 ± 6.8	4.0 ± 1.0	661 ± 49	48.9 ± 6.0	0.69 ± 0.25
	24 h	22	91 ± 4^ab	10.8 ± 2.9	71.8 ± 5.7	37.2 ± 5.3	3.4 ± 0.5^ab	668 ± 51	48.2 ± 6.0	0.76 ± 0.16
	48 h	22	90 ± 4^ab	11.5 ± 2.5	70.0 ± 8.8	36.9 ± 4.2	3.3 ± 0.4^ab	698 ± 51^ab	47.8 ± 5.5	0.85 ± 0.19^ab
	72 h	22	87 ± 4^ab	11.8 ± 3.4	72.4 ± 6.5	37.3 ± 4.8	3.2 ± 0.4^ab	729 ± 45^ab	48.7 ± 5.1	0.92 ± 0.21^ab
	96 h	22	87 ± 7^ab	11.3 ± 2.6	71.9 ± 7.0	38.5 ± 5.4	3.4 ± 0.6^ab	738 ± 40^ab	50.5 ± 6.1	1.03 ± 0.19^ab
F值			58.045	0.732	1.120	1.263	11.102	7.132	0.689	7.136
P值			< 0.001	0.397	0.296	0.268	0.002	0.011	0.411	0.011

组别	时间点	例数	cTnI（μg/L）	脑钠尿肽（ng/L）	血乳酸（mmol/L）	ScvO₂
对照组	0h	22	0.83 ± 0.51	712 ± 113	8.2 ± 3.9	0.742 ± 0.036
	24 h	22	0.97 ± 0.55	632 ± 130	5.0 ± 2.4	0.742 ± 0.040
	48 h	22	0.75 ± 0.56	608 ± 234	5.0 ± 1.0	0.744 ± 0.044
	72 h	22	0.73 ± 0.64	582 ± 127^a	2.3 ± 1.1	0.754 ± 0.052
	96 h	22	0.32 ± 0.24^a	311 ± 85^a	1.7 ± 0.6	0.764 ± 0.051
治疗组	0 h	22	0.97 ± 0.53	666 ± 70	7.5 ± 3.6	0.740 ± 0.042
	24 h	22	0.93 ± 0.57	652 ± 140	5.2 ± 1.5	0.761 ± 0.057
	48 h	22	0.62 ± 0.50^a	558 ± 83^a	4.8 ± 1.1	0.765 ± 0.057
	72 h	22	0.37 ± 0.32^ab	468 ± 105^ab	2.1 ± 1.0	0.772 ± 0.040
	96 h	22	0.13 ± 0.09^ab	209 ± 75^ab	1.9 ± 0.9	0.779 ± 0.052
F值			2.970	3.006	0.619	0.565
P值			0.028	0.030	0.652	0.661

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