Carrara Marta, Herpain Antoine, Ferrario Manuela
Annu Int Conf IEEE Eng Med Biol Soc. 2020 Jul;2020:2756-2759. doi: 10.1109/EMBC44109.2020.9175624.
Persisting tachycardia is often observed in resuscitated septic shock patients, and it is an independent risk factor for increased mortality. Recently, several drugs, such as esmolol and ivabradine, have been proved to be beneficial in HR control, but their overall impact on cardiac functions needs further investigation. The aim of this study is to study the effects of the two drugs on heart function in a protocol of polymicrobial septic shock and resuscitation. Twelve pigs were divided into three experimental groups: the esmolol-treated group (n=4), the ivabradine-treated group (n=5) and the control group (n=3). Cardiac autonomic activity was estimated by heart rate variability (HRV) indices and baroreflex sensitivity (BRS). The Buckberg index was adopted to evaluate myocardial oxygenation efficiency. Septic shock induced a severe autonomic dysfunction and a lower cardiac efficiency, not resolved by fluids resuscitation. The administration of the drugs improved both the HRV and the BRS, but this favourable condition was preserved after noradrenaline administration only in the esmolol group. The interaction of esmolol with the autonomic system is beneficial in septic shock to restore an improved condition of HRV and control, while ivabradine is not as effective when administered in adjunction to noradrenaline.
在复苏后的感染性休克患者中经常观察到持续性心动过速，并且它是死亡率增加的独立危险因素。最近，几种药物，如艾司洛尔和伊伐布雷定，已被证明在控制心率方面有益，但它们对心脏功能的总体影响需要进一步研究。本研究的目的是在多微生物感染性休克和复苏方案中研究这两种药物对心脏功能的影响。将12只猪分为三个实验组：艾司洛尔治疗组（n = 4）、伊伐布雷定治疗组（n = 5）和对照组（n = 3）。通过心率变异性（HRV）指数和压力反射敏感性（BRS）评估心脏自主神经活动。采用巴克伯格指数评估心肌氧合效率。感染性休克导致严重的自主神经功能障碍和较低的心脏效率，液体复苏无法解决。药物给药改善了HRV和BRS，但仅在艾司洛尔组中，去甲肾上腺素给药后这种有利状态得以维持。艾司洛尔与自主神经系统的相互作用在感染性休克中有利于恢复HRV和控制的改善状态，而伊伐布雷定与去甲肾上腺素联合给药时效果不佳。
