Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anesthesiology, Washington University in Saint Louis, Saint Louis, MO, USA.
Anaesth Intensive Care. 2021 Sep;49(5):366-378. doi: 10.1177/0310057X211009913. Epub 2021 Aug 18.
Persistent tachycardia in patients with septic shock predicts poor outcome. This study sought to investigate the effect of the cardiac pacemaker current inhibitor ivabradine on heart rate and cardio-circulatory function in patients with septic shock. After informed consent, 60 patients with septic shock and persistent tachycardia (heart rate >95 /minute) were prospectively randomly assigned to receive either standard therapy for septic shock (group S) or standard therapy along with enteral ivabradine (group I) for the initial 96 hours after enrolment. Primary outcome was the difference in heart rate between the two groups during the first 96 hours. Secondary outcomes included the effect of ivabradine on haemodynamic, oxygenation, myocardial function and organ function parameters, incidence of adverse events and 30-day overall survival. Heart rate was lower in group I compared to group S (median difference in area under the curve -25.6 (95% confidence intervals -31.4 to -15.9) /minute; <0.001). Vasopressor requirements, blood lactate levels, Sequential Organ Failure Assessment scores and E/e' ratio were lower in group I compared to group S. Stroke volume index and ejection fraction were higher in group I while cardiac index and oxygen delivery parameters were maintained similar to group S. There was no difference in 30-day mortality or in the incidence of serious adverse events. Enteral ivabradine is effective in reducing heart rate, and improving haemodynamic parameters and cardiac function in patients with septic shock and persistent tachycardia, without increasing the incidence of adverse events.
持续性心动过速的感染性休克患者预后不良。本研究旨在探讨心脏起搏器电流抑制剂伊伐布雷定对感染性休克患者心率和心循环功能的影响。在获得知情同意后，60 例持续性心动过速（心率＞95 次/分钟）的感染性休克患者被前瞻性随机分为标准感染性休克治疗组（S 组）或标准感染性休克治疗加伊伐布雷定肠内治疗组（I 组），两组均在纳入后 96 小时内接受治疗。主要终点是两组患者在最初 96 小时内心率的差异。次要终点包括伊伐布雷定对血流动力学、氧合、心肌功能和器官功能参数、不良事件发生率以及 30 天总生存率的影响。与 S 组相比，I 组患者的心率较低（曲线下面积差异中位数-25.6（95%置信区间-31.4 至-15.9）/分钟；＜0.001）。与 S 组相比，I 组的血管加压素需求、血乳酸水平、序贯器官衰竭评估评分和 E/e' 比值较低。I 组的每搏量指数和射血分数较高，而心指数和氧输送参数与 S 组相似。两组 30 天死亡率或严重不良事件发生率无差异。肠内伊伐布雷定可有效降低心率，改善感染性休克伴持续性心动过速患者的血流动力学参数和心功能，且不增加不良事件发生率。
