| Research background:Septic shock induced circulation failure and mitochondria i njury cause the dysfunction of ATP generation in cell,and then cause the deficit of energy and cell death.To reduce risk of cell death and limit energy consumpti on,the adaptation of cell was activated to reduce part of function and create a n ew balance between supply and consumption.The myocardial cells were survived in dormant state.Once the infection was controlled and re-supply the energy of c ells,the myocaridal cells will restore the contraction function.Study form the mec hanism of cell adaptation and protection, the β agonist maybe not change the pat ients’ prognosis.In this situation,β antagonist used in septic shock patients becom e more and more popular but there are only a few study about this,and the exist ed study were small sample clinical research or study focused on using β antago nist before admitted in ICU,so need further study.Objects:This study was conducted by feeding metoprolol with nasogastric tube to treat septic shock patients and observe the effect of hemodynamics,cardiac function and oxygen metabolism,then to evaluate the safety of the treatment and explore the mechanism and provide reference to clinical practice and sequential study.Methods:This is prospective randomized controlled trial.Totally 50 patients marched the inclusive criteria and divided into two groups according to whether using metoprolol or not,each group contain 25 patients.Evaluation indexes:1.evaluate balance of all the patients’ general information;2.Major evaluation indexes:mortality,length ofstay,mechanical ventilation time;3.haemodynamics and cardiac function indexes,such as HR,MAP,CI,SVI,SVRI,CVP,NT-pro BNP,dosage of NE and liquid requirement each day;4.Oxygen Metabolism Indexes,such as Scv O2 and lactate.Results:1.The general information of two groupsThere were no any statistical difference in age,gender,classification of diseases,APACHE II score,Dosages of NE,Indexes of PICCO after resuscitation,Lac,Scvo2 and comorbidity.The baseline is balance and comparable.2.The change of circulation function after treatment.The HR of two groups increased significantly before treatment.After treatment,the HR of experimental group decreased significantly compared with baseline(p<0.05 or p<0.01).Contrasted to control group,the HR of experimental group were slower at 24 h,(p<0.01).the HR of control group decreased significantly compared with baseline at 48 h,72h and 96h(p<0.05,p<0.01 and p<0.01).There was no statistical difference in MAP of two groups(p>0.05) and compared with baseline at each time point,there also were not any statistically different(p>0.05).Contrasted to control group,the dosage of NE using in experimental group did not reduced significantly(p>0.05) and also did not reduced significantly when compared with baseline at 72 h and 96h(p<0.05,p<0.01).The dosages using in control group did not reduced significantly contrasted to baseline(p>0.05).3.The cardiac function in two groups.There were no statistical differences of CI at each time point between the two groups(p>0.05).The CI of both group have a reduction tendency after treatment but did not have statistical difference compared with baseline(p>0.05).There were no statistical differences of d Pmx at each time point between the two groups(p>0.05).The d Pmx of both group have a reduction tendency after treatment but did not have statistical difference compared with baseline(p>0.05).Compared with baseline,the SVI ofexperimental group increased obviously and also increased significantly when contrasted to control group after 6h.The SVI of control group also increased at each time point after 6h,but the range and speed was lower than experimental group(p<0.05 or p<0.01).Compared with baseline,the CVP of experimental group reduced significantly after 6h at each time point(p<0.05 or p<0.01) and the CVP of control group reduced significantly after 96h(p<0.05).When contrasted to control group,the CVP reduced statistically significant after 6h at each time point.The NT-pro BNP has a fluctuant tendency and reach the peak at 48 h which has statistical difference compared with baseline(p<0.05) and reduced significantly at 96h(p<0.01).When contrasted to control group the NT-pro BNP level were lower at 48 h,72h and 96h(p<0.05).The control group has the same fluctuant tendency and then maintain at a high level.The SVRI of two groups show a escalating tendency and have statistical differences at 72 h and 96 h compared with baseline(p<0.05).There was not any statistically different between the two groups of SVRI(p>0.05).4.The indexes of oxygen metabolism in two groups.There were no statistical differences of Scv O2 between the two groups at each time point(p>0.05).Compared with the baseline,the Scv O2 of experimental group was significant higher(p<0.05),but there were no statistical differences in control group at each time point(p>0.05).After treatment,the Lac of experimental group reduced significantly compared with baseline(p<0.05 or p<0.01) and when contrasted to control group,the Lac of experimental group reduced obviously at 6h(p<0.05),but has no statistical difference at other time points(p<0.05 or p<0.01).5.Liquid requirement of the two groups.Compared with control group,the liquid requirement was statistically significant lower in 24-48 h,48-72 h and 72-96 h period(p<0.05 or p<0.01).6.Major indexes of two groupsThere is a tendency of decrease of experimental group in ICU mortality,28 days mortality,in-hospital mortality,mechanical ventilation time and length of ICU stay,but does not have statistical differences(p>0.05).But the length of hospital stay in experimental group was shorter than control group(p<0.05).Conclusions1.Metoprolol can reduce cardiac oxygen consumption,improve cardiac function and protect organs in septic shock patients.2.Metoprolol can stabilize hemodynamics state,not increase vasoactive agents using and can reduce lactate in septic shock patients.3.Using Metoprolol with nasogastric tube to treat septic shock is useful and worth continually researching. |
PDF Full Text Request