血管手术后射血分数降低的重症监护病房患者撤机期间兰地洛尔与艾司洛尔对血流动力学反应的比较

Comparison of Landiolol and Esmolol on Haemodynamic Responses During Weaning of Intensive Care Unit Patients with Reduced Ejection Fraction after Vascular Surgery.

作者信息

Koukoulitsios Georgios, Tsikritsaki Kyriaki, Magklaras Georgios, Koutivas Athanasios M, Kalogeromitros Alexandros, Papaioannou Vasileios

机构信息

ICU Department, General Hospital of Athens 'Georgios Gennimatas' Athens, Greece.

ICU Department, University Hospital, Democritus University of Thrace Alexandroupolis, Greece.

出版信息

Card Fail Rev. 2025 May 21;11:e13. doi: 10.15420/cfr.2024.18. eCollection 2025.

DOI:10.15420/cfr.2024.18

PMID:40458288

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12127960/

Abstract

BACKGROUND

Weaning and tracheal extubation of patients after vascular surgery is a stressful procedure that triggers the sympathetic nervous system, potentially leading to deterioration of cardiac performance in patients with left ventricular dysfunction. This study compared the efficacy and safety of landiolol, a novel ultra-short-acting β-adrenoceptor antagonist, with that of esmolol in terms of the cardiovascular response during the extubation of patients with reduced ejection fraction (EF) admitted to the intensive care unit after major vascular surgery.

METHODS

This single-centre, prospective, randomised, open-label study included postoperative patients with cardiac dysfunction. Patients were randomly assigned to either landiolol or esmolol. Landiolol and esmolol infusions began as soon as the respiratory weaning procedure started, and were initiated at doses of 1 and 50 µg/kg/min, respectively (up to 10 and 200 µg/kg/min, respectively). Heart rate, systolic arterial pressure, diastolic arterial pressure, mean arterial pressure (MAP) and cardiac rhythm were recorded every minute up to 30 minutes after extubation.

RESULTS

Thirty-nine patients with cardiac dysfunction (mean [±SD] left ventricular EF 36.6 ± 7.6%; New York Heart Association Class II/III, 32/9) were infused with either landiolol (n=19; mean rate 2.0 ± 2.1 μg/kg/min) or esmolol (n=20; mean rate 150 ± 50 μg/kg/min). Mean age, left ventricular EF, New York Heart Association class and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were similar between the two groups. Landiolol produced a more rapid and substantial decrease in heart rate than esmolol (-40 ± 20 BPM versus -30 ± 16 BPM) without haemodynamic deterioration. A significant reduction in MAP was recorded in the esmolol group.

CONCLUSION

Landiolol produced a more rapid and potent reduction in heart rate than esmolol. A significant reduction in MAP was only seen in the esmolol group.

摘要

背景

血管手术后患者的撤机和气管拔管是一个应激过程，会触发交感神经系统，可能导致左心室功能不全患者的心功能恶化。本研究比较了新型超短效β肾上腺素能受体拮抗剂兰地洛尔与艾司洛尔在重症监护病房接受大血管手术后射血分数（EF）降低的患者拔管期间心血管反应方面的疗效和安全性。

方法

这项单中心、前瞻性、随机、开放标签研究纳入了术后心脏功能不全患者。患者被随机分配至兰地洛尔组或艾司洛尔组。一旦开始呼吸撤机程序，即开始输注兰地洛尔和艾司洛尔，起始剂量分别为1和50μg/kg/min（最高分别为10和200μg/kg/min）。拔管后30分钟内每分钟记录心率、收缩压、舒张压、平均动脉压（MAP）和心律。

结果

39例心脏功能不全患者（平均[±标准差]左心室EF 36.6±7.6%；纽约心脏协会II/III级，32/9）接受了兰地洛尔（n = 19；平均速率2.0±2.1μg/kg/min）或艾司洛尔（n = 20；平均速率150±50μg/kg/min）输注。两组患者的平均年龄、左心室EF、纽约心脏协会分级以及急性生理与慢性健康状况评分II和序贯器官衰竭评估评分相似。兰地洛尔使心率降低的速度比艾司洛尔更快且幅度更大（-40±20次/分钟对-30±16次/分钟），且未出现血流动力学恶化。艾司洛尔组记录到MAP显著降低。