Objective: To investigate the effect of esmolol in septic shock patients with tachycardia. Methods: A prospective randomized controlled trial was conducted. Screening septic shock patients that admitted to Department of General Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University from June 2016 to August 2017. After 24 h resuscitation therapy, 100 cases of septic shock patients with tachycardia (heart rate>100 bpm) were divided into esmolol group (n=50) and control group (n=50) with random number table. Patients in esmolol group accepted standard treatment plus esmolol injection with an initial dose of 25 mg/h. Heart rate target is 80 to 100 bpm. Patients in esmolol group continued to use esmolol for 7 days or to the day the patient left the ICU when the heart rate didn't achieve the target. Patients in control group were given standard treatment. Primary outcome was 28 d mortality. Secondary outcomes included heart rate, norepinephrine dosages, lactate level, inflammatory markers in per day during the trial; acute physiology and chronic health evaluation (APACHE Ⅱ) and sequential organ failure assessment (SOFA) on day 1, 3, 5, 7; length of hospital stay, length of mechanical ventilation, medication time of vasoactive agent. The data were compared with t test or rank sum test between the two groups. Results: The 28 d mortality of esmolol group and control group was 62%, 68%, respectively(χ(2)=0.529, P=0.529). Logistic regression analysis showed that primary heart rate (increase of 10 bpm, OR=1.568, 95%CI: 1.039-1.238, P=0.027), primary APACHEⅡ (OR=1.134, 95%CI: 1.026-1.239, P=0.005), integral heart rate (per 10 bpm, OR=2.207, 95%CI: 1.400-3.479, P=0.001) were independent risk factors for 28 d mortality. Compared with control group, the esmolol group had a lower heart rate on day 1-7; but over all, there was no statistically significant difference in heart rate between the two groups (P>0.05). There was no significant difference in total does of norepinephrine, lactate level, inflammatory markers, APACHE Ⅱ, SOFA, length of hospital stay between the two groups (all P>0.05). Conclusion: Tachycardia significantly increases the risk of death in patients with septic shock, esmolol may decrease the mortality by controlling heart rate.
目的： 探讨艾司洛尔对脓毒性休克伴心动过速患者预后的影响。 方法： 单中心随机对照研究，以2016年6月至2017年8月入住郑州大学第一附属医院综合ICU的脓毒性休克患者为初筛对象，将经过24 h补液等抗休克治疗后心率仍≥100次/min的患者纳入研究，按随机数字法分为艾司洛尔组与对照组。艾司洛尔组在标准治疗的基础上应用艾司洛尔，起始剂量为25 mg/h，以80~100次/min为目标心率调整剂量，若心率持续未达标，则持续应用艾司洛尔7 d或至患者离开ICU。对照组给予标准治疗，心率不作特殊干预和要求。主要终点事件：28 d病死率；次要终点事件是：1~7 d的心率水平、去甲肾上腺素用量、乳酸、感染指标，第1、3、5、7天急性生理功能和慢性健康状况评分（APACHE Ⅱ）及序贯器官衰竭评分（SOFA），住院时间，呼吸机及升压药应用时间。两组间正态分布的计量资料比较采用t检验，非正态分布资料采用秩和检验。 结果： 共100例患者纳入研究，两组各50例。艾司洛尔组和对照组28 d病死率分别为62.0%和68.0%，差异无统计学意义（χ(2)=0.529，P=0.529）。多因素logistics回归分析显示，28 d病死率的影响因素是：初始心率（每10次/min，OR=1.568，95%CI：1.039~1.238，P=0.027），治疗前APACHEⅡ评分（OR=1.134，95%CI：1.026~1.239，P=0.005）；总体心率水平（每10次/min，OR=2.207，95%CI：1.400~3.479，P=0.001）。艾司洛尔组第1~7天心率水平均低于对照组，但整体心率水平差异无统计学意义（P>0.05）；与对照组相比，艾司洛尔组去甲肾上腺素总量、乳酸、感染指标、APACHEⅡ评分、SOFA评分、住院时间等差异均无统计学意义（均P>0.05）。 结论： 心率增快明显增加脓毒性休克患者的死亡风险。应用艾司洛尔可以适当控制心率，且有降低病死率的趋势。.
Keywords: Esmolol; Septic shock; β-blocker.