Meta Analysis On The Effect Of Esmolol On Hemodynamics And Prognosis In Patients With Septic Shock

Objective: More and more evidences suggest ?-blockers therapy can improve the hemodynamics and prognosis of sepsis or septic shock patients.This study aims to evaluate the effect of esmolol on hemodynamics,tissue perfusion,cardiac function and prognosis of septic shock patients through meta-analysis.Methods:A systematic review was performed through PUBMED,EMBASE,OVID,Cochrane Library,CNKI,WANFANG and VIP databases.Studies published to December 31,2015,which contained the key words,esmolol,beta blockers,sepsis and septic shock(both in Chinese and English),were included.These studies were selected according to the inclusion and exclusion criteria and were evaluated for the quality.Relevant data,such as 28-daymortality,hemodynamics,perfusion index and cardiac function was extracted.Meta-analysis were performed using thestatistical software RevMan 5.3 to compare differences on mortality,hemodynamic parameters,cardiac function and tissue perfusion of septic shock patients between the experimental and control group.Results: A total of seven prospective randomized controlled studies were selected,of which two was in English and five in Chinese.Meta-analysis showed that esmolol group is lower than control group on 28-day mortality of septic shock patients,the difference was statistically significant(RR=0.59,95%CI=0.47~0.73,Z=4.76,P < 0.01).The esmolol group is lower than control group on heart rate of patients with septic shock,the difference was statistically significant(SMD =-2.58,95% CI =-3.49 ~-1.67,Z = 5.56,P<0.01).Esmolol had no significant effect on hemodynamic indexes,such as mean arterial pressure,central venous pressure and cardiac index(P>0.05).Esmolol has no significant effect on lactate level within 48 hours(SMD=?0.95,95%CI=?1.97~0.06,Z=1.84,P=0.07),but esmolol group is lower than control group on lactate level within 72 hours,the difference was statistically significant(SMD= ? 0.90,95%CI= ? 1.66~ ? 0.14,Z=2.32,P=0.02).Moreover,esmolol has no significant effect on left ventricular ejection fraction(P>0.05),but it is higher than control group on the E/A of the patients,the difference was statistically significant(MD = 0.10,95% CI = 0.05~0.15,Z = 3.96,P <0.01).Conclusions:1 Esmolol can significantly improve the prognosis of patients with septic shock.2 Esmolol can reduce heart rate and stabilize hemodynamic of patients with septic shock.3 Esmolol can improve tissue perfusion after72 hours of patients with septic shock.4 Esmolol has no effect on cardiac systolic function,but it can significantly improve patient's cardiac diastolic function.