Department of Critical Care Medicine, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550001, China.
Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, 264000, China.
BMC Anesthesiol. 2024 Sep 12;24(1):326. doi: 10.1186/s12871-024-02714-3.
Sepsis is associated with a high incidence and mortality and poses a significant challenge to the treatment. Although esmolol has shown promise in sepsis treatment, its efficacy and safety remain contentious. This meta-analysis aims to clarify the role of esmolol in sepsis management.
PubMed, Embase, Web of Science, Cochrane library, clinicaltrials.gov and the Chinese Clinical Trial Registry were searched and references of relevant reviews and meta-analysis were also screened for appropriate studies. Keywords and free words of 'sepsis', 'esmolol' and 'randomized controlled trials' were used for search. Meta-analysis was performed using RevMan 5.3 software.
Fifteen studies involving 1100 patients were included. Compared with the control group, patients receiving esmolol exhibited significantly decreased 28-day mortality (RR, 0.69; 95% CI, 0.60 to 0.81; P < 0.0001), heart rate (HR) (SMD, -1.15; 95% CI, -1.34 to -0.96; P < 0.0001), cardiac troponin I levels (cTnI) (SMD, -0.88; 95% CI, -1.13 to -0.64; P < 0.0001), length of intensive care unit (ICU) stay (SMD, -0.46; 95% CI, -0.62 to -0.3; P < 0.0001) and duration of mechanical ventilation (SMD, -0.28; 95% CI, -0.48 to -0.09; P = 0.004) and significantly increased central venous oxygen saturation (ScvO) (SMD, 0.66; 95% CI, 0.44 to 0.88; P < 0.0001).While, esmolol had no significant influence on norepinephrine dosage (SMD, 0.08; 95% CI, -0.13 to 0.29; P = 0.46), mean arterial pressure (MAP) (SMD, 0.17; 95% CI, -0.07 to 0.4; P = 0.16), central venous pressure (CVP) (SMD, 0.16; 95% CI, -0.04 to 0.35; P = 0.11) and left ventricular ejection fraction (LVEF) (SMD, 0.21; 95% CI, -2.9 to 0.7; P = 0.41).
Esmolol reduces 28-day mortality, length of ICU stay and duration of mechanical ventilation in sepsis patients. Furthermore, esmolol improves oxygen metabolism, mitigates myocardial injury and decreases heart rate without significantly affecting hemodynamic parameters.
This study was registered on the PROSPERO website (registration number: CRD42023484884).
脓毒症的发病率和死亡率都很高，对治疗构成了重大挑战。虽然艾司洛尔在脓毒症治疗中显示出了一定的疗效，但它的疗效和安全性仍存在争议。本荟萃分析旨在阐明艾司洛尔在脓毒症管理中的作用。
检索了 PubMed、Embase、Web of Science、Cochrane 图书馆、clinicaltrials.gov 和中国临床试验注册中心，筛选了相关综述和荟萃分析的参考文献，以获取合适的研究。使用“脓毒症”、“艾司洛尔”和“随机对照试验”的关键词和自由词进行搜索。使用 RevMan 5.3 软件进行荟萃分析。
纳入了 15 项涉及 1100 名患者的研究。与对照组相比，接受艾司洛尔治疗的患者 28 天死亡率显著降低（RR，0.69；95%CI，0.60 至 0.81；P<0.0001），心率（HR）（SMD，-1.15；95%CI，-1.34 至-0.96；P<0.0001），心肌肌钙蛋白 I 水平（cTnI）（SMD，-0.88；95%CI，-1.13 至-0.64；P<0.0001），重症监护病房（ICU）住院时间（SMD，-0.46；95%CI，-0.62 至-0.3；P<0.0001）和机械通气时间（SMD，-0.28；95%CI，-0.48 至-0.09；P=0.004），并显著增加中心静脉血氧饱和度（ScvO）（SMD，0.66；95%CI，0.44 至 0.88；P<0.0001）。然而，艾司洛尔对去甲肾上腺素剂量（SMD，0.08；95%CI，-0.13 至 0.29；P=0.46）、平均动脉压（MAP）（SMD，0.17；95%CI，-0.07 至 0.4；P=0.16）、中心静脉压（CVP）（SMD，0.16；95%CI，-0.04 至 0.35；P=0.11）和左心室射血分数（LVEF）（SMD，0.21；95%CI，-2.9 至 0.7；P=0.41）没有显著影响。
艾司洛尔可降低脓毒症患者 28 天死亡率、ICU 住院时间和机械通气时间。此外，艾司洛尔改善了氧代谢，减轻了心肌损伤，降低了心率，而对血流动力学参数没有显著影响。
本研究在 PROSPERO 网站上进行了注册（注册号：CRD42023484884）。
