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| Effect of adrenergic β1-antagonists on hemodynamic and inflammatory responses in patients with
septic shock |
| ZENG Wen-xin, JIANG Wen-qiang, HUANG Cheng, WEN Miao-yun, ZENG Hong-ke |
| Emergency & Intensive Care Unit, Guangdong Provincial People's Hospital, Guangzhou 510080, China |
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Abstract Objective To explore the effects of heart rate control with Esmolol on hemodynamic,clinical outcomes and inflammatory responses of patients with septic shock. Methods A prospective randomized controlled trial was conducted. Seventy-five patients with septic shock in accordance with early goal directed treatment and met the target within 6 hours, and admitted to intensive care unit（ICU）of Guangdong General Hospital from October 2014 to September 2015 were enrolled. The ptientswere divided into treatment group（n＝38）and control group（n＝37）by random number table. Patients in control group were given conventional treatment, while patients in treatment group were given conventional treatment and Esmolol through central venous catheter in order to control the heart rate（HR）within 80~94 bpm. Various indices（heart rate, systolic blood pressure）, diastolic blood pressure,cardiac output, cardiac index, central venous pressure, systemic vascular resistance index and stroke volume index）were monitored by a multifunctional and hemodynamic monitor connected to PICCO. Indices of arterial lactate（Lac）concentration, central vena cava oxygen saturation（ScvO2）were measured by a blood-gas-analyzer 10 minutes before and 48 hours after the treatment, and the serum C-reaction protein（CRP）, procalcitonin（PCT）, tumor necrosis factor-α（TNF-α）and interleukin-1β（IL-1β）levels were measured. The acute physiology and chronic health evaluation Ⅱ（APACHEⅡ）score were recorded every day, ICU care duration and 28 days survival rate were recorded, and survival analysis was used to assess 28 days prognosis. Results Heart rate reduction after 48 hours of the treatment group were bigger than that of the control （[-24.3±3.2）bpm vs.（-6.7±2.5）bpm, P＜0.05]. Rise of stroke volume index and ScvO2 in the treatment group were bigger than that of the control （[4.6±1.1）mL/m2 vs.（1.2±0.3）mL/m2, P＜0.05;（2.3±1.1）mmol/L vs.（1.1±0.4）mmol/L, P＜0.05]. Lac decreased significantly at 48 hours in the treatment group and increased in the control （[-0.15±0.03）mmol/L vs.（0.21±0.04）mmol/L, P＜0.05]. The differences of CRP, PCT, TNF-α and IL-1β before treatment in the two groups were not statistically significant. After 48 h of the treatment, the CRP, PCT, TNF-α and IL-1β of treatment group were significantly lower than those of the control group. The ICU care duration in the treatment group was significantly shorter than that in the control group （[3.5±2.1）d vs.（5.4±3.2）d, P＜0.05]; the patients in the treatment group lived longer than those in the control group（χ2＝4.348, P＜0.05）. The 28-day mortality was significantly lower than that of the control group（21.1% vs. 43.2%, P＜0.05）. Conclusion After EGDT target is reached, heart rate control（within 80~94 bpm）with Esmolol may increase stroke volume index and ScvO2, reduce Lac and improve prognosis in patients with septic shock. The effect may be related to inhibiting inflammatory response by Esmolol.
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Received: 24 November 2015
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Corresponding Authors:
ZENG Hong-ke, E-mail: zenghongke@vip.163.com
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