目的：探讨艾司洛尔对脓毒症患者心肌损伤的保护作用。方法采用前瞻性随机对照研究方法，选取2012－01～2015－01入住兰州大学第二医院MICU的脓毒症并发心肌损伤患者62例，随机数字表法分为对照组（29例）和治疗组（33例），对照组给予脓毒症常规治疗，治疗组在此基础上持续静脉泵入艾司洛尔（将心率控制在60～100次／min，以此为目标滴定艾司洛尔剂量），持续监测心率（HR）、平均动脉压（MAP）、中心静脉压（CVP）。对照组和治疗组分别于入ICU后0、1、3、7 d采血检测动脉血乳酸（ Lac）、中心静脉血氧饱和度（ ScvO2）、cTnT、BNP、TNF－α、IL－1β及心脏彩超测量左室射血分数（ LVEF）、二尖瓣环收缩期峰值速度（ Sm）、二尖瓣环舒张期早期峰值速度（Ea）与舒张晚期峰值速度（Aa）比值（Ea／Aa）。观察两组患者入院28 d死亡率。结果与对照组比较，治疗组各时间点cTnT、BNP、TNF－α、IL－1β水平明显下降（P均＜0．05）， HR明显减慢（P＜0．05），Ea／Aa明显升高（P＜0．05），MAP、LVEF和Sm差异无统计学意义（P均＞0．05），两组28 d死亡率比较差异无统计学意义（P＞0．05）。结论艾司洛尔对脓毒症患者心肌损伤具有保护作用，这种作用可能与下调炎症反应有关。%Objective To explore the protective effect of esmolol on myocardial injury in septic patients.Methods A prospective randomized controlled trial was conducted.Sixty two septic patients with myocardial injury, admitted to medical intensive care unit ( MICU) of Lanzhou University Second Hospital from January 2012 to January 2015, were randomly divided into control group( n=29) and treatment group ( n =33 ) .Patients in control group were given standard treatment of sepsis, while patients in treatment group accepted standard treatment plus esmolol injection in order to control the heart rate between 60 bpm and 100 bpm.All patients accepted continuous monitoring of heart rate (HR), mean arterial pressure ( MAP) , central venous pressure ( CVP) .Serum indexes, including lactic acid ( Lac) , central venous oxygen saturation ( ScvO2 ) , cTnT, BNP, tumor necrosis factor-α( TNF-α) and interleukin-1β( IL-1β); and the changes of LVEF, Sm and Ea/Aa were also observed in all patients by echocardiography at various time points ( 0 d, 1 d, 3d and 7 d of treatment ) .28 day mortality of the two groups was observed. Results Changes of all indexes were not significantly different between control group and treatment group ( P>0 .05)before treatment .Compared with control group, esmolol injection significantly decreased serum cTnT, BNP, TNF-α, IL-1βand HR, and elevated Ea/Aa ( P<0.05 ); but changes of MAP, LVEF, Sm, Lac, ScvO2 and28 day mortality were not significantly different between the two groups ( P >0.05 ).Conclusion Esmolol can improve myocardial injury of septic patients, probably through down-regulating the inflammatory responses.
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