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.
3.	王永清, 樊尋梅.膿毒癥及感染性休克時心肌抑制的炎癥介質機制.小兒急救醫學, 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.
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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.	莊海舟, 沈潞華.膿毒癥時心肌損傷發生機制研究進展.實用醫學雜志, 2008, 24:4313-4315.
8.	耿麗娟, 李素瑋, 張永利, 等.膿毒癥心肌損傷發病機制的研究進展.中華內科雜志, 2015, 54:77-80.
9.	劉安雷, 劉潔, 于鶯, 等.膿毒癥心功能障礙研究進展.中國急救醫學, 2011, 31:847-850.
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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.	楊圣強, 劉貞, 楊文寶, 等.β受體阻滯劑對膿毒性休克患者的心臟保護作用及對血流動力學影響的前瞻性研究.中華危重病急救醫學, 2014, 26:714-717.
17.	陳軍喜, 孫堅, 劉艷陽, 等.腎上腺素能β1受體阻滯劑對重度膿毒癥患者血流動力學的影響.中華醫學雜志, 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.	王濤, 夏永富, 郝東, 等.乳酸在膿毒性休克早期診斷及目標導向治療中的意義.中華危重病急救醫學, 2014, 26:51-55.
21.	管向東, 寇秋野.感染性休克血流動力學的監測指標.創傷外科雜志, 2007, 9:97-99.

1. 高戈, 馮喆, 常志剛, 等. 2012國際嚴重膿毒癥及膿毒性休克診療指南.中華危重病急救醫學, 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, 樊尋梅.膿毒癥及感染性休克時心肌抑制的炎癥介質機制.小兒急救醫學, 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. 嚴靜, 李莉.膿毒癥心肌損傷與血流動力學.醫學新知雜志, 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. 莊海舟, 沈潞華.膿毒癥時心肌損傷發生機制研究進展.實用醫學雜志, 2008, 24:4313-4315.
8. 耿麗娟, 李素瑋, 張永利, 等.膿毒癥心肌損傷發病機制的研究進展.中華內科雜志, 2015, 54:77-80.
9. 劉安雷, 劉潔, 于鶯, 等.膿毒癥心功能障礙研究進展.中國急救醫學, 2011, 31:847-850.
10. 余海洋.膿毒癥性心功能不全的發生機制.中國急救醫學, 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. 楊圣強, 劉貞, 楊文寶, 等.β受體阻滯劑對膿毒性休克患者的心臟保護作用及對血流動力學影響的前瞻性研究.中華危重病急救醫學, 2014, 26:714-717.
17. 陳軍喜, 孫堅, 劉艷陽, 等.腎上腺素能β1受體阻滯劑對重度膿毒癥患者血流動力學的影響.中華醫學雜志, 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. 王濤, 夏永富, 郝東, 等.乳酸在膿毒性休克早期診斷及目標導向治療中的意義.中華危重病急救醫學, 2014, 26:51-55.
21. 管向東, 寇秋野.感染性休克血流動力學的監測指標.創傷外科雜志, 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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