Friese Randall S, Barber Robert, McBride Dara, Bender Jessica, Gentilello Larry M
Division of Burn, Trauma, Critical Care, Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA.
J Trauma. 2008 Apr;64(4):1061-8. doi: 10.1097/TA.0b013e3181684cf0.
Cardioprotection with beta-receptor antagonists improves outcome in high risk patients undergoing elective surgery. Recent trials have demonstrated an association between beta blocker (BB) use and improved outcomes after injury. The mechanisms through which BB result in improved outcomes remain poorly elucidated. In vitro evidence supports that BB modulates the postinjury inflammatory response. The purpose of this study was to examine the effects of BB on inflammatory profiles in injured patients at increased risk for heart disease.
A pseudo-randomized, controlled trial of injured patients over 55 admitted to the intensive care unit was conducted. Patients were randomized to receive continuous BB or standard of care. Patients with a reported history of prehospital BB use were enrolled into an observational arm of the trial, continued on BB, and analyzed with the continuous BB group. Plasma interleukin (IL)-6 and IL-1beta levels were measured by enzyme-linked immunosorbent assay at baseline and day 1, 2, and 4 after BB initiation. Cytokine data were log transformed for normality assumptions. Repeated measures analysis of variance was used to test for within-group differences in cytokine levels over time.
Forty-two patients were enrolled. Seventeen patients were randomized to the control group and 25 patients received continuous BB (10 randomized/15 observational). There was no difference in gender, age, prior history of heart disease, or admission heart rate, systolic blood pressure or initial base deficit between groups. Baseline levels of IL-6 and IL-1beta did not differ between groups. Levels of IL-6, but not IL-1beta, decreased over time in patients receiving BB (p = 0.04), whereas levels in controls remained unchanged (p = 0.27). There were no BB related complications.
Use of BB decreases serum IL-6 levels over time in injured patients at risk for heart disease. This may contribute to improved outcomes noted in trauma patients receiving BB. Additionally, BB use in this population of patients is safe after endpoints of resuscitation have been met.
β受体拮抗剂的心脏保护作用可改善接受择期手术的高危患者的预后。近期试验表明，使用β受体阻滞剂（BB）与损伤后预后改善之间存在关联。BB改善预后的机制仍未完全阐明。体外证据支持BB可调节损伤后的炎症反应。本研究旨在探讨BB对心脏病风险增加的受伤患者炎症指标的影响。
对入住重症监护病房的55岁以上受伤患者进行了一项伪随机对照试验。患者被随机分为接受持续BB治疗组或标准治疗组。有院前使用BB报告史的患者被纳入试验的观察组，继续使用BB，并与持续BB治疗组一起进行分析。在基线以及开始使用BB后的第1、2和4天，通过酶联免疫吸附测定法测量血浆白细胞介素（IL）-6和IL-1β水平。为符合正态性假设，对细胞因子数据进行对数转换。采用重复测量方差分析来检验细胞因子水平随时间的组内差异。
共纳入42例患者。17例患者被随机分配至对照组，25例患者接受持续BB治疗（10例随机分组/15例观察性分组）。两组在性别、年龄、既往心脏病史、入院心率、收缩压或初始碱缺失方面无差异。两组间IL-6和IL-1β的基线水平无差异。接受BB治疗的患者中，IL-6水平随时间下降（p = 0.04），而IL-1β水平未下降，而对照组水平保持不变（p = 0.27）。未出现与BB相关的并发症。
对于有心脏病风险的受伤患者，使用BB可随时间降低血清IL-6水平。这可能有助于解释接受BB治疗的创伤患者预后改善的原因。此外，在达到复苏终点后，该人群使用BB是安全的。
