Effects of Metoprolol on Hemodynamics of Early Septic Shock Patients with Myocardial Injury_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 ChiRuibin , LeiLin , JianZhigang , LiuLixin

Department of Critical Care Medicine, Xiaolan Hospital of Southern Medical University, Zhongshan, Guangdong, 528415, China;

Corresponding author：

ChiRuibin, Email: CRB77970922@163.com

Keywords：

Metoprolol; Septic shock; Myocardial injury; Hemodynamics

DOI：

10.7507/1671-6205.2016013

Video：

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Objective To explore the effects of metoprolol on hemodynamics of early septic shock patients with myocardial injury. Methods We prospectively recruited 22 septic shock patients with myocardial injury, who were admitted to the ICU of Xiaolan Hospital during March 2014 and February 2015.The metoprolol was injected through central venous catheter to reduce heart rate by 20% from baseline and maintain for 6h.Hemodynamic and oxygen metabolic parameters were collected to establish database. Results Heart rate decreased significantly to (98±18), (95±16) and (92±18) beat/min respectively at 1h, 3h and 6h post-dosing, compared with (125±28) beat/min at pre-dosing (P < 0.05).Cardiac index decreased significantly to (3.2±1.5), (3.3±1.9) and (3.3±1.6) L·min^-1·m^-2 respectively at 1h, 3h and 6h post-dosing, compared with (3.9±2.5) L·min^-1·m^-2 at pre-dosing (P < 0.05).The mean blood pressure, central venous pressure, pulmonary artery wedge pressure, pulmonary vascular resistance index, systemic vascular resistance index and stroke volume index showed no significant changes between pre-dosing and post-dosing (all P > 0.05). Lactate concentration decreased significantly to (9.8±4.1) and (8.1±3.6)mmol/L respectively at 3h and 6h post-dosing, compared with (13.4±5.2)mmol/L at pre-dosing (all P < 0.05), but mixed venous oxygen saturation showed no significant changes (P > 0.05). Conclusion Metoprolol may reduce heart rate and cardiac output in septic shock patients with myocardial injury, without obvious adverse effects on circulatory function and systemic perfusion.

Citation： ChiRuibin, LeiLin, JianZhigang, LiuLixin. Effects of Metoprolol on Hemodynamics of Early Septic Shock Patients with Myocardial Injury. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(1): 53-56. doi: 10.7507/1671-6205.2016013 Copy

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2.	Du B, An Y, Kang Y, et al. Characteristics of critically ill patients in ICUs in mainland China. Crit Care Med, 2013, 41:84-92.
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8.	耿丽娟, 李素玮, 张永利, 等.脓毒症心肌损伤发病机制的研究进展.中华内科杂志, 2015, 54:77-80.
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11.	Rudiger A. Beta-block the septic hear. Crit Care Med, 2010, 38:S608-S612.
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13.	Dünser MW, Hasibeder WR.Sympathetic overstimulation during critical illness:adverse effects of adrenergic stress. J Intensive Care Med, 2009, 24:293-316.
14.	Jeschke MG, Finnerty CC, Kulp GA, et al. Combination of recombinant human growth hormone and propranolol decreases hypermetabolism and inflammation in severely burned children. Pedialr Crit Care Med, 2008, 9:209-216.
15.	Balik M, Rulisek J, Leden P, et al. Is cardioprotective beta-blockade feasible in severe sepsis? A pilot study. Int Care Med, 2011, 37(Suppl 1):S89.
16.	杨圣强, 刘贞, 杨文宝, 等.β受体阻滞剂对脓毒性休克患者的心脏保护作用及对血流动力学影响的前瞻性研究.中华危重病急救医学, 2014, 26:714-717.
17.	陈军喜, 孙坚, 刘艳阳, 等.肾上腺素能β1受体阻滞剂对重度脓毒症患者血流动力学的影响.中华医学杂志, 2013, 93:1243-1246.
18.	Fox K, Borer Js, Camm AJ, et al.Resting heart rate in cardiovascular disease.J Am Coll Cardiol, 2007, 50:823-830.
19.	Parker MM, Shelhamcr JH, Natansen C, et al.Serial cardiovascular variables in survivors and nonsurvivors of human septic shock:heart rate an early predictor of prognosis. Crit Care Med, 1987, 15:923-929.
20.	王涛, 夏永富, 郝东, 等.乳酸在脓毒性休克早期诊断及目标导向治疗中的意义.中华危重病急救医学, 2014, 26:51-55.
21.	管向东, 寇秋野.感染性休克血流动力学的监测指标.创伤外科杂志, 2007, 9:97-99.

1. 高戈, 冯喆, 常志刚, 等. 2012国际严重脓毒症及脓毒性休克诊疗指南.中华危重病急救医学, 2013, 25:501-505.
2. Du B, An Y, Kang Y, et al. Characteristics of critically ill patients in ICUs in mainland China. Crit Care Med, 2013, 41:84-92.
3. 王永清, 樊寻梅.脓毒症及感染性休克时心肌抑制的炎症介质机制.小儿急救医学, 2005, 12:151-153.
4. Aboab J, Sebille V, Jourdain M, et al. Effects of esmolol on systemic and pulmonary hemodynamics and on oxygenation in pigs with hypodynamic endotoxin shock. Intensive Care Med, 2011, 37:1344-1351.
5. 严静, 李莉.脓毒症心肌损伤与血流动力学.医学新知杂志, 2012, 22:1-3, 8.
6. Jozwiak M, Persichini R, Monnet X, et al.Management of myocardial dysfunction in severe sepsis.Semin Respir Crit Care Med, 2011, 32:206-214.
7. 庄海舟, 沈潞华.脓毒症时心肌损伤发生机制研究进展.实用医学杂志, 2008, 24:4313-4315.
8. 耿丽娟, 李素玮, 张永利, 等.脓毒症心肌损伤发病机制的研究进展.中华内科杂志, 2015, 54:77-80.
9. 刘安雷, 刘洁, 于莺, 等.脓毒症心功能障碍研究进展.中国急救医学, 2011, 31:847-850.
10. 余海洋.脓毒症性心功能不全的发生机制.中国急救医学, 2011, 31:173-177.
11. Rudiger A. Beta-block the septic hear. Crit Care Med, 2010, 38:S608-S612.
12. Novotnv NM, Lahm T, Markel TA, et al. Beta-blockers in sepsis:reexamining the evidence.Shock, 2009, 31:113-119.
13. Dünser MW, Hasibeder WR.Sympathetic overstimulation during critical illness:adverse effects of adrenergic stress. J Intensive Care Med, 2009, 24:293-316.
14. Jeschke MG, Finnerty CC, Kulp GA, et al. Combination of recombinant human growth hormone and propranolol decreases hypermetabolism and inflammation in severely burned children. Pedialr Crit Care Med, 2008, 9:209-216.
15. Balik M, Rulisek J, Leden P, et al. Is cardioprotective beta-blockade feasible in severe sepsis? A pilot study. Int Care Med, 2011, 37(Suppl 1):S89.
16. 杨圣强, 刘贞, 杨文宝, 等.β受体阻滞剂对脓毒性休克患者的心脏保护作用及对血流动力学影响的前瞻性研究.中华危重病急救医学, 2014, 26:714-717.
17. 陈军喜, 孙坚, 刘艳阳, 等.肾上腺素能β1受体阻滞剂对重度脓毒症患者血流动力学的影响.中华医学杂志, 2013, 93:1243-1246.
18. Fox K, Borer Js, Camm AJ, et al.Resting heart rate in cardiovascular disease.J Am Coll Cardiol, 2007, 50:823-830.
19. Parker MM, Shelhamcr JH, Natansen C, et al.Serial cardiovascular variables in survivors and nonsurvivors of human septic shock:heart rate an early predictor of prognosis. Crit Care Med, 1987, 15:923-929.
20. 王涛, 夏永富, 郝东, 等.乳酸在脓毒性休克早期诊断及目标导向治疗中的意义.中华危重病急救医学, 2014, 26:51-55.
21. 管向东, 寇秋野.感染性休克血流动力学的监测指标.创伤外科杂志, 2007, 9:97-99.

Chinese Journal of Respiratory and Critical Care Medicine

Effects of Metoprolol on Hemodynamics of Early Septic Shock Patients with Myocardial Injury

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