Hennen R, Friedrich I, Hoyer D, Nuding S, Rauchhaus M, Schulze M, Schlisske S, Schwesig R, Schlitt A, Buerke M, Müller-Werdan U, Werdan K, Schmidt H
Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg.
Dtsch Med Wochenschr. 2008 Nov;133(48):2500-4. doi: 10.1055/s-0028-1100944. Epub 2008 Nov 19.
The multiple organ dysfunction syndrome (MODS), a failure of two or more organ systems, is the endstage of initial trigger events in diseases such as acute coronary syndrome or sepsis. The mortality is high (40 - 60 %). The present study aimed to detect whether beta-adrenergic blockers (BAB) which may affect sympathetic-parasympathetic balance have a positive influence on outcome.
Data on 157 patients with MODS (83 male, 74 female, mean age 61.3 +/- 13.4 years) were retrospectively analysed concerning BAB medication and autonomic dysfunction. A 24-hour-Holter-ECG which had been applied within the initial 48 hours of illness was analysed for heart rate variability (HRV). All patients were followed to determine 28-day mortality.
69 of the 157 MODS patients had received BAB. This treatment was associated with a higher survival probability (hazard ratio [HR] 0.4, 95 % confidence interval [CI] 0.23 - 0.68; p = 0.001). Survival benefit was especially seen in the subgroup of MODS patients who had an ischemically triggered MODS (HR 0.2 [0.1 - 0.5], p = 0.001). HRV was less reduced in the BAB group compared to patients without this medication.
MODS patients treated with beta-adrenercic blockers may have a survival benefit which is especially seen in the subgroup of MODS patients with ischemically triggered MODS. Moreover, BAB medication is associated with a less pronounced autonomic dysfunction in MODS (especially the vagal modulation of heart rate) which might result in a lower inflammatory response. Hence, future prospective studies have to show the relevance of beta-adrenergic blockers in MODS.
多器官功能障碍综合征（MODS）是两个或更多器官系统功能衰竭的状态，是急性冠状动脉综合征或脓毒症等疾病初始触发事件的终末期。其死亡率很高（40%-60%）。本研究旨在检测可能影响交感-副交感神经平衡的β-肾上腺素能阻滞剂（BAB）是否对预后有积极影响。
回顾性分析157例MODS患者（83例男性，74例女性，平均年龄61.3±13.4岁）使用BAB药物治疗及自主神经功能障碍的数据。分析在发病最初48小时内进行的24小时动态心电图以评估心率变异性（HRV）。对所有患者进行随访以确定28天死亡率。
157例MODS患者中有69例接受了BAB治疗。这种治疗与较高的生存概率相关（风险比[HR]0.4，95%置信区间[CI]0.23-0.68；p=0.001）。生存获益在因缺血引发MODS的患者亚组中尤为明显（HR 0.2[0.1-0.5]，p=0.001）。与未使用该药物的患者相比，BAB组的HRV降低程度较小。
接受β-肾上腺素能阻滞剂治疗的MODS患者可能有生存获益，这在因缺血引发MODS的患者亚组中尤为明显。此外，BAB药物治疗与MODS中自主神经功能障碍不那么明显相关（尤其是心率的迷走神经调节），这可能导致较低的炎症反应。因此，未来的前瞻性研究必须证明β-肾上腺素能阻滞剂在MODS中的相关性。
