2019•Chin J Crit Care Med(Electronic Edition)Requires access
Clinical study on the cardioprotection of esmolol in patients with septic shock
Chun Yang, Cheng Wang, Ting Chen, Jinpeng Wang, Yinyan Weng, Zhizhen Lai, Jianbiao Meng, Hailin Li
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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