艾司洛尔对脓毒性休克患者血流动力学及炎症反应的影响

目的:探讨艾司洛尔对脓毒性休克患者血流动力学及炎症反应的影响。方法: 将92例脓毒性休克患者分为观察组和对照组，每组46例。对照组采用米力农治疗。观察组采用艾司洛尔联合米力农治疗。对比两组治疗前后的心率（HR）、平均动脉压（MAP）、心指数（CI）、每搏输出量指数（SVI）、血乳酸（Lac）。采用心脏彩超仪检测患者心功能变化，包括左室射血分数（LVEF）、二尖瓣舒张早期峰值流速（E）/二尖瓣舒张晚期峰值流速（A）。采用急性生理与慢性健康评分（APACHE-II）和序贯器官衰竭估计评分（SOFA）评估患者病情变化。对比两组治疗前后炎症指标降钙素（PCT）、C反应蛋白（CRP）、白细胞计数（WBC）的变化。结果: 两组治疗后的CI、SVI均明显升高，Lac明显降低（P<0.05）；治疗后，观察组的CI、SVI明显高于对照组，Lac明显低于对照组，差异有统计学意义（P<0.05）；观察组治疗后E/A的水平明显升高，且显著高于对照组治疗后，差异有统计学意义（P<0.05）；两组治疗后的APACHE II评分、SOFA评分较治疗前均明显降低（P<0.05）；治疗后，观察组的APACHE II评分、SOFA评分明显低于对照组，差异有统计学意义（P<0.05）；两组治疗后的PCT、CRP、WBC较治疗前均明显降低（P<0.05）；治疗后，观察组的PCT、CRP、WBC明显低于对照组，差异有统计学意义（P<0.05）。结论:艾司洛尔能显著减轻脓毒性休克患者的炎症反应，改善血流动力学水平。

Effects of esmolol on hemodynamics and inflammatory response in patients with septic shock

AIM: To investigate the effects of esmolol on hemodynamics and inflammatory response in patients with septic shock. METHODS: Ninety two patients with septic shock were divided into observation group and control group, with 46 cases in each group. The control group received milrinone treatment while the observation group received esmolol combined milrinone. Heart rate (HR), mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI) and lactic acid (Lac) were compared between the two groups before and after treatment. Heart function changes were detected by echocardiography, including left ventricular ejection fraction (LVEF), mitral valve peak diastolic flow velocity (E)/mitral valve peak diastolic flow velocity (A). The acute physiology and chronic health evaluation (APACHE-II) and sequential organ failure assessment (SOFA) were used to assess the changes in the patient's condition. The changes of inflammatory indexes (PCT, CRP, and WBC) before and after treatment were compared between the two groups. RESULTS:After treatment, the levels of CI and SVI in the two groups were significantly increased while Lac decreased significantly (P<0.05); CI, SVI and the level of E/A in the observation group were significantly higher than those in the control group while Lac was significantly lower than that in the control group (P<0.05). The scores of APACHE II and SOFA in the two groups were significantly lower than those before treatment (P<0.05); after treatment, the scores of APACHE II and SOFA in the observation group were significantly lower than those in the control group (P<0.05); the levels of PCT, CRP and WBC in the two groups were significantly lower than those before treatment (P<0.05). After treatment, the PCT, CRP and WBC in the observation group were significantly lower than those in the control group (P<0.05). CONCLUSION: Esmolol can significantly reduce the inflammatory response and improve the hemodynamic level in patients with septic shock.