β受体阻滞剂在脓毒性休克患者中的应用进展

白 婧1 王君艳 2 张丽香 3

1.内蒙古医科大学包头临床医学院急诊科，内蒙古 包头 014040

2.内蒙古包头市中心医院重症医学科，内蒙 省包头 014040

3.内蒙古包头市中心医院临床药学科，内蒙古 包头 014040

摘要：脓毒症是一种危及生命且具有时间依赖性的疾病，脓毒性休克被视为脓毒症的一个子集，它的特点是死亡率、治疗成本和发病率高。脓毒症及脓毒性休克状态下的患者会出现应激反应，感染反应会损伤心肌造成心律失常，严重者会危及生命，而应用药物干预来减轻过度应激反应对改善患者疾病预后具有重要意义。近年研究表明，在脓毒性休克治疗中β受体阻滞剂发挥着良好的作用，其能拮抗肾上腺素的作用，对抗应激反应时交感神经过度兴奋；能有效的控制心率从而保护心脏；能改善氧输送，对微循环的灌注起到积极作用；能抑制促炎因子及促炎蛋白，从而减轻全身炎症反应；通过调节免疫信号通路，促进机体有益的免疫调节；能调节全身代谢，避免分解代谢过度；能使血小板活化减少和降低纤溶活性，从而改善促凝状态；能减轻脓毒症脑病的认知障碍和神经元炎症，起到脑保护作用，对脓毒性休克患者的预后有所改善，是治疗脓毒性休克潜在的药物。本文对β受体阻滞剂治疗脓毒性休克的应用研究及相关机制进行综述。

关键词：脓毒症；脓毒性休克；β受体阻滞剂；艾司洛尔；综述

中图分类号：R472

Progress in the use of beta blockers in septic shock patients

BAI Jing 1WANG Junyan2 ZHANG LiXiang3

1.Inner Mongolia Medical University Baotou Clincial College,Emergency Department,Inner Mongolia Baotou 014040

2.Inner Mongolia Baotou Central Hospital Department of Critical Care Medicine,Inner Mongolia Baotou 014040

3.Inner Mongolia Baotou Central Hospital Department of Clinical pharmacy,Inner Mongolia Baotou 014040

  Abstract:Sepsis is a life-threatening and time-dependent disease,and septic shock is considered a subset of sepsis,which is characterized by high mortality,treatment costs,and morbidity.Patients with sepsis and septic shock will have stress reaction,which will damage the myocardium and lead to arrhythmia,and in severe cases will be life-threatening.However,the application of drug intervention to reduce excessive stress reaction is of great significance to improve the prognosis of patients.Recent studies have shown that β receptor blockers play a good role in the treatment of septic shock,which can antagonize the effect of adrenaline and resist the overexcitation of sympathetic nerve during stress response.Can effectively control the heart rate to protect the heart;can improve oxygen delivery,play a positive role in the perfusion of microcirculation;It can inhibit pro-inflammatory factors and pro-inflammatory proteins,thereby reducing systemic inflammatory response;By regulating the immune signaling pathway,the body can promote beneficial immune regulation;can regulate the body metabolism,avoid excessive catabolism can reduce platelet activation and reduce fibrinolytic activity,so as to improve the procoagulant state;It can alleviate the cognitive impairment and neuronal inflammation of septic encephalopathy,play a brain protective effect,and improve the prognosis of patients with septic shock.It is a potential drug for the treatment of septic shock.This article reviews the application and mechanism of blockers in the treatment of septic shock.

      Keywords:sepsis;septic shock;beta blocker;esmolol;review

  脓毒症被定义为因宿主对感染反应失调而引起的危及生命的器官功能障碍。脓毒性休克被定义为脓毒症的一种亚型，表现为循环、细胞和代谢不稳定，与脓毒症本身相比死亡风险更高[1]。感染性休克的定义是，在充分的液体复苏后，需要使用升压药来维持平均动脉压（mean arterial pressure，MAP）≥65 mmHg 和血清乳酸水平≥2 mmol/L。脓毒症和脓毒性休克由于其发病率不断增加以及病理生理、分子、遗传和临床的复杂性，成为全球日益增长的主要负担和挑战[1–3]。自1991年第一个共识定义以来，脓毒症和脓毒性休克的发病率不断增加，2017年全球约有4900万例脓毒症病例和1100万例脓毒症相关死亡[4]。由于脓毒性休克患者病情复杂，且治疗性操作较多，常会加重患者应激水平，导致原发病进一步加重[5]。“过度应激反应”会对患者产生不利影响，造成自身组织器官功能损害，而用药物干预来减轻“过度应激反应”对改善患者疾病预后具有重要意义。下面主要针对艾司洛尔为代表的选择性β1 受体阻滞剂的作用机制进行综述。