β受体阻断剂倍他乐克对对脓毒症休克患者心肌损伤BNP水平影响.doc

β受体阻断剂倍他乐克对对脓毒症休克患者心肌损伤BNP水平影响【摘要】目的:通过倍他乐克干预脓毒症休克患者的BNP水平，从而了解β受体阻断剂对脓毒症患者BNP水平的影响。方法:共入选68例住ICU感染性休克患者，分别分为两组，36例给予抗感染集束化常规治疗、32例给予集束化常规治疗及倍他乐克治疗，倍他乐克给予12.5mg日二次口服。入选患者常规检查入院后第1天、第7天及第14天的BNP、C反应蛋白、血清肌酸激酶及APACHEⅡ评分，采用t检验分析比较两组上述的变化。结果：倍他乐克组治疗第7天及第14天的BNP、C反应蛋白、血清肌酸激酶水平及APACHEⅡ评分，较对照组有明显的降低。结论：β受体阻断剂倍他乐克能有效降低脓毒血症休克病人的BNP水平及死亡率。 【关键词】倍他乐克；脑利钠肽APACHEⅡ 【中图分类号】R541.6【文献标识码】B【文章编号】1008-6455（2011）08-0410-02 β-receptor blocker Betaloc on myocardial injury in septic shock patients the level of BNP Zhou Xiuhua Fang Lihui 【Abstract】Objective：To study β-receptor blockers on BNP levelsthrough interventionbymetoprolol in patients with septic shock, To understand BNP levels in patients with sepsis. Methods：68patients were enrolled ICU patients with septic shock to live, who were divided into two groups, 36 patients given conventional therapy of anti-infective cluster, cluster of 32 patients given conventional treatment and metoprolol treatment, Metoprololwas given 12. .5 mg twice a day orally. Selected for routine examination of patients 1 day after admission, 7 days and 14 days of the BNP level, C-reactive protein, serum creatine kinase and APACHE Ⅱ score, two groups were compared using t test analysis of the changes. Results:Metoprolol treatment group on day 7 and 14 days of BNP, C-reactive protein, serum creatine kinase levels and the APACHE Ⅱ score, than the control group significantly reduced. Conclusion：β-receptor blocker metoprolol can reduce the septic shock patients in the BNP level and mortality. 【Key words】Betaloc; brain natriuretic peptide;APACHE Ⅱ 脓毒症（sepsis）是感染所致的全身炎症反应综合征，病情进展迅速，临床救治困难，是危重患者死亡的首要原因[1]。1951年，Waisbren首先报道脓毒症可导致心肌抑制[2]，特征为收缩功能损害，心脏扩大、射血分数下降、对容量负荷收缩反应差、收缩峰值/收缩末期容积比值下降等。近50%脓毒症患者出现不同程度的心肌抑制，病死率可高达70%～90%[3]。脑利钠肽（BNP）是一种心脏分泌的循环激素，目前BNP已成为心衰诊断、治疗及判断预后的重要指标[4]。最近的研究显示脓毒症休克患者血浆BNP水平升高，本研究探讨倍他乐克对对脓毒症心肌损伤的影响。 1 资料与方法 1.1 临床资料:68例病例均来自中国医科大学ICU病房，其中男性44例、女性34例、年龄18岁～86岁，平均年龄（62±16）岁，感染性休克诊断按照ACCP/SCCM制定标准。[5]分为两组，36例给予抗感染集束化常规治疗（常规