Hemodynamic and metabolic effects of selective β1 adrenergic blockade during sepsis
Hemodynamic and metabolic effects of selective β1 adrenergic blockade during sepsis
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DOI：
10.1016/j.surg.2005.10.010
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发表时间：
2006-05-01
期刊：
影响因子：
3.8
通讯作者：
Wolfe, RR
中科院分区：
文献类型：
--
作者：
Gore, DC;Wolfe, RR
背景资料。选择性β-肾上腺素能拮抗剂通常用于减少心脏相关死亡风险患者的心肌死亡。本研究的目的是观察心脏选择性β受体阻滞剂对患者血流动力学和代谢的影响。用同位素示踪法对6例中度败血症、机械通气的肺炎患者在输注足够剂量的艾司洛尔3h结束前和结束时的肌肉蛋白运动进行了定量。在选择性β受体阻滞剂阻断3小时前和3小时后，通过热稀释、肺动脉导管和间接量热法测量一系列血流动力学指标。选择性β受体阻滞剂与心率减慢20%和心输出量相应减少相关。艾司洛尔给药不影响全身或肺血管阻力、氧耗、肝脏或腿部血流量、能量消耗或肌肉内三磷酸腺苷的利用率/能量负荷。艾司洛尔静脉滴注确实刺激了燃料氧化向棕榈酸酯氧化增加和葡萄糖氧化减少的转变。结论肾上腺素能受体阻滞剂对肌肉蛋白动力学无明显影响。使用艾司洛尔的心脏选择性β-肾上腺素能阻滞剂减少中度严重脓毒症患者的心输出量，与心率下降的百分比成比例，而不会对氧气利用或肝脏和外周血流产生不利影响。
Background. Selective beta adrenergic antagonists are commonly used to reduce myocardial demise in patients at risk for cardiac-related death. The purpose of this study was to examine the hemodynamic and metabolic effects of cardiac selective beta adrenergic blockade in patients.Methods. Muscle protein kine tics were quantified using isotopic tracer methodology in 6 moderately septic, mechanically ventilated patients with pneumonia before and then at the conclusion of a 3-hour infusion of esmolol of sufficient dose to reduce heart rate by 20% from baseline. A battery of hemodynamic measurements as facilitated by a. thermodilution pulmonary artery catheter and indirect calorimetry were also measured before and after the 3-hour selective beta adrenergic blockade.Results. Selective beta adrenergic blockade was associated with the 20% reduction in heart rate and a comparable decrease in cardiac output. Esmolol administration failed to affect systemic or pulmonary vascular resistance, oxygen consumption, hepatic or leg blood flow, energy expenditure, or ATP availability/energy charge within muscle. Esmolol infuse did incite a shift in fuel oxidation toward an increase in palmitate oxidation and with a decrease in the oxidation of glucose. There was no demonstrable influence P, adrenergic blockade on muscle protein kinetics.Conclusions. Cardiac selective beta adrenergic blockade with esmolol reduces cardiac output in proportion to the percentage decreases in heart rate in moderately severe septic patients without adversely affecting oxygen utilization or hepatic, peripheral blood flow.