Esmolol In Sinus Tachycardia After Congenital Heart Disease Clinical Study

ObjectiveTo evaluate the efficacy and safety Of esmolol in children with congenital heart disease (CHD) after the clinical application of sinus tachycardia, Observe their children after operation for congenital heart hemodynamics, cardiac function, as well as children in the Cardiac intensive care unit(CICU) cardiac drug treatment time, sedative drug use frequency, breathing machine with a tube time, and kept under observation time of impact.Materials and methodsThe 40 cases of congenital heart disease postoperative sinus tachycardia were randomly divided into two groups, Esmolol group (n=20):Heart rate greater than 160 beats/min, during sedation, cooling, supplementary blood volume and correct electrolyte disorders after treatment, heart rate decreased insignificantly, in the case of excluding contraindications, such as severe heart failure, etc. to be the first load of esmolol0.5mg/kg intravenous rapid injection, followed by0.05～0.1mg/kg.min continuous intravenous pump until the children with heart rate down and the gradual stabilization of withdrawal.Conventional therapy group(n=20):heart rate greater than 160 beats/min,Given conventional treatment, including sedation, analgesia, to correct electrolyte disorders, digitalis and so on. Outcome measures:The patients were 40 cases of children with continuous monitoring of heart rate, blood pressure, after the first 6 hours, every 30 minutes record the data, after recording a time for every 1 hour, until after 48 hours, were selected before treatment, medication immediately,30 minutes,1 hour,3 hours heart rate, systolic blood pressure, diastolic blood pressure, right atrial pressure, on average, at the same time line bedside echocardiography, record medication before the medication immediately,30 minutes, 1 hour,3 hours each point of ejection fraction and shortening fraction, Analyzing and comparing two groups of children with cardiac medication time, the number of sedative drug use, CICU ventilator with a tube time and time of observation with CICU.Results1 Two drugs during the five time heart rate (HR),the difference was statistically significant (P<0.05);the two groups in each time point heart rate (HR) on the changes in contrast, the difference was statistically significant (P<0.05),Esm group have a faster effect than in Con Group to Control heart rate(HR),in Con group, heart rate (HR) decreased slowly.2 Two drugs during the five time systolic blood pressure(SBP),the difference was statistically significant (P<0.05);the two groups in each point in time systolic blood pressure(SBP) on the changes in contrast, the difference was statistically significance (P<0.05),Esm group have the faster effect than in Con group to control of systolic blood pressure(SBP),at the same time Esm group control it and it has been very stable.3 Two drugs during the five time diastolic blood pressure (DBP),the difference was statistically significant (P<0.05);the two groups in each point in time diastolic blood pressure (DBP) on the changes in contrast, the difference was statistically significance (P<0.05),Esm group have the faster effect than in Con group to control of diastolic blood pressure (DBP),at the same time Esm group control and has beevery stable.4 Two drugs during the five time periods right atrial pressure (RAP),the difference was not statistically significant (P>0.05);the two groups in each time point right atrial pressure(RAP)on the changes in contrast, have no difference in statistically significant (P>0.05).5 Two drugs during the five time periods ventricular ejection fraction(EF),the difference was statistically significant (P<0.05);the two groups in each time point ventricular ejection fraction(EF) on the changes in contrast, the difference was not statistically significant (P>0.05),Esm Group EF values fell within 30 minutes after administration, and after 30 minutes,Esm Group have an increasing tendency, while the Con group was slightly increased within 30 minutes after the drug, but increased obviously after 30 minutes. 6 Two drugs during the five time periods ventricular fractional shortening (FS), the difference was statistically significant (P<0.05);the two groups in each time point ventricular fractional shortening (FS)on the changes in contrast, the difference was not statistically significant (P>0.05),Esm Group FS value fell within 30 minutes after administration, and after 30 minutes Esm Group have an increasing tendency,while the Con group was slightly increased within 30 minutes after the drug.7 Cardiotonic drug treatment time in Esm Group is shorter than that in Con group, the difference was statistically significant (P<0.05);At the same time with the Con group, the number of sedative drug use is fewer, ventilator with a tube have a shorter time, as well as the observation have a shorter time, the difference was statistically significant (P<0.05).ConclusionEsmolol for the treatment of sinus tachycardia after congenital heart disease, can effectively reduce and control the sinus tachycardia, maintain a stable heart rate, blood pressure, on cardiac output, ventricular ejection fraction,with no adverse effect,it reduce myocardial contractility while improving ventricular diastolic function. Therefore, a clear cause and contraindications of the premise, choose the right medication program in all kinds of complicated, severe congenital heart disease of early postoperative sinus tachycardia, Esmolol is effective, safe.