美托洛尔对感染性休克合并心肌损伤患者临床预后的影响
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摘要
目的:分析感染性休克早期合并心肌损伤患者的临床预后情况,初步探讨美托洛尔对其临床预后的影响。方法:回顾分析2014-03—2017-07期间在我院ICU住院的42例感染性休克合并心肌损伤患者的临床资料及预后情况,根据治疗初期是否使用美托洛尔治疗分为美托洛尔组和非美托洛尔组,比较两组患者的一般资料、感染来源、临床预后、心脏标志物、住院病死率及28d病死率。根据临床预后情况分为28d死亡组和28d存活组,比较两组间患者救治初期的临床危重度、心脏标志物以及美托洛尔使用情况等。结果:①整个研究人群住院病死率为28.5%,28d病死率为35.7%。美托洛尔组的住院病死率和28d病死率(分别为22.7%和35.0%)低于非美托洛尔组(分别为27.3%和45.0%),但差异无统计学意义(P>0.05)。②28d死亡组的APACHEⅡ评分、N端脑钠肽前体(NT-pro-BNP)及高敏肌钙蛋白T(cTNT)均明显高于28d存活组[分别为(28±5)vs.(21±3)分,(1760±370)vs.(1250±230)pg/ml和(323±75)vs.(228±56)pg/ml],差异有统计学意义(P<0.05)。③与28d死亡组比较,28d存活组在初始治疗中采用美托洛尔方案的患者数更多,差异有统计学意义(P<0.05)。结论:感染性休克合并心肌损伤患者病情危重,NT-proBNP、cTNT水平明显升高者预后更差,美托洛尔可能降低其住院病死率和28d病死率。
Objective:To analyze the clinical prognosis of septic shock patients with myocardial injury,and to explore the effect of metoprolol on its clinical prognosis.Method:In this study,we retrospectively analysed the clinical data of 42 septic shock patients with myocardial injury,who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University during March 2014 to July 2017.The patients were divided into metoprolol group and non-metoprolol group according to the therapeutic schemes,meanwhile divided into 28 d death group and 28 dsurvival group according to the clinical outcomes.Clinical severity,the therapy of metoprolol,heart biomarkers and other index were collected to establish database and compared in different groups.Result:In this cohort,in-hospital mortality was 28.5% and 28 dmortality was 35.7%,which were lower in metoprolol group than non-metoprolol group(P>0.05).The levels of NT-pro-BNP,cTNT and APACHEⅡ score were significantly higher in 28 ddeath group than 28 dsurvival group[(28±5)&(21±3)score,(1760±370)&(1250±230),(323±75)&(228±56)pg/ml,all P<0.05].Compared with the 28 ddeath group,more patients in the28 dsurvival group adopted the therapy of metoprolol in the early stage of septic shock(P<0.05).Conclusion:Septic shock with myocardial injury is a severe disease,in which significant elevation in NT-proBNP and cTNT levels indicates a worse prognosis.Metoprolol may reduce the in-hospital mortality and 28-day mortality in these patients,and improve their clinical outcomes.
Objective:To analyze the clinical prognosis of septic shock patients with myocardial injury,and to explore the effect of metoprolol on its clinical prognosis.Method:In this study,we retrospectively analysed the clinical data of 42 septic shock patients with myocardial injury,who had been admitted to the adult mixed ICU of Xiaolan Hospital of Southern Medical University during March 2014 to July 2017.The patients were divided into metoprolol group and non-metoprolol group according to the therapeutic schemes,meanwhile divided into 28 d death group and 28 dsurvival group according to the clinical outcomes.Clinical severity,the therapy of metoprolol,heart biomarkers and other index were collected to establish database and compared in different groups.Result:In this cohort,in-hospital mortality was 28.5% and 28 dmortality was 35.7%,which were lower in metoprolol group than non-metoprolol group(P>0.05).The levels of NT-pro-BNP,cTNT and APACHEⅡ score were significantly higher in 28 ddeath group than 28 dsurvival group[(28±5)&(21±3)score,(1760±370)&(1250±230),(323±75)&(228±56)pg/ml,all P<0.05].Compared with the 28 ddeath group,more patients in the28 dsurvival group adopted the therapy of metoprolol in the early stage of septic shock(P<0.05).Conclusion:Septic shock with myocardial injury is a severe disease,in which significant elevation in NT-proBNP and cTNT levels indicates a worse prognosis.Metoprolol may reduce the in-hospital mortality and 28-day mortality in these patients,and improve their clinical outcomes.
引文
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[9]池锐彬,林婷,周卉芬,等.感染性休克早期心肌损伤患者应用β受体阻滞剂的安全性探讨[J].内科急危重症杂志,2016,22(1):48-50.
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[12]McLean AS,Huang SJ,Nalos M,et al.The confounding effects of age,gender,serum creatinine,and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients[J].Crit Care Med,2003,31(11):2611-2618.
[13]Favory R,Neviere R.Significance and interpretation of elevated troponin in septic patients[J].Crit Care,2006,10(4):224.
[14]Novotnv NM,Lahm T,Markel TA,et al.Beta blockers in sepsis:reexamining the evidence[J].Shock,2009,31:113-119.
[15]Parker MM,Shelhamcr JH,Natansen C,et al.Serial cardiovascular variables in survivors and nonsurvivors of human septic shock:heart rate an early predictor of prognosis[J].Crit Care Med,1987,15(10):923-929.
[16]池锐彬,雷玲,简志刚,等.美托洛尔对感染性休克早期心肌损伤患者血流动力学的影响[J].中国呼吸与危重监护杂志,2016,15(1):53-56.
[2]庄海舟,沈潞华.脓毒症时心肌损伤发生机制研究进展[J].实用医学杂志,2008,24(24):4313-4315.
[3]Esper AM,Martin GS.Extending international sepsis epidemiology:the impact of organ dysfunction[J].Crit Care,2009,13(1):120.
[4]Aboab J,Sebille V,Jourdain M,et al.Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shock[J].Int Care Med,2011,37(8):1344-1351.
[5]Morelli A,Ertmer C,Westphal M,et al.Effect of heart rate control with esmolol on hemodynamic and clinical outcomes in patients with septic shock:a randomized clinical trial[J].JAMA,2013,310(16):1683-1691.
[6]Dellinger RP,Levy MM,Rhodes A,et al.Surviving sepsis campaign:international guidelines for management of severe sepsis and septic shock:2012[J].Crit Care Med,2013,41(2):580-637.
[7]严静,李莉.脓毒症心肌损伤与血流动力学[J].医学新知杂志,2012,22(1):1-3,8.
[8]Jozwiak M,Persichini R,Monnet X,et al.Management of myocardial dysfunction in severe sepsis[J].Semin Respir Crit Care Med,2011,32(2):206-214.
[9]池锐彬,林婷,周卉芬,等.感染性休克早期心肌损伤患者应用β受体阻滞剂的安全性探讨[J].内科急危重症杂志,2016,22(1):48-50.
[10]Guest TM,Ramanathan JH,Tuteur PG,et al.Myocardial injury in critically ill patients[J].JAMA,1995,273(24):1945.
[11]Turner A,Tsamitros M,Bellomo R,et al.Myocardial cell injury in septic shock[J].Crit Care Med,1999,27(9):2035-2036.
[12]McLean AS,Huang SJ,Nalos M,et al.The confounding effects of age,gender,serum creatinine,and electrolyte concentrations on plasma B-type natriuretic peptide concentrations in critically ill patients[J].Crit Care Med,2003,31(11):2611-2618.
[13]Favory R,Neviere R.Significance and interpretation of elevated troponin in septic patients[J].Crit Care,2006,10(4):224.
[14]Novotnv NM,Lahm T,Markel TA,et al.Beta blockers in sepsis:reexamining the evidence[J].Shock,2009,31:113-119.
[15]Parker MM,Shelhamcr JH,Natansen C,et al.Serial cardiovascular variables in survivors and nonsurvivors of human septic shock:heart rate an early predictor of prognosis[J].Crit Care Med,1987,15(10):923-929.
[16]池锐彬,雷玲,简志刚,等.美托洛尔对感染性休克早期心肌损伤患者血流动力学的影响[J].中国呼吸与危重监护杂志,2016,15(1):53-56.