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目的观察早期使用β受体阻滞剂对全身炎症反应综合征(SIRS)患者预后的影响。方法选择2011年1—12月北京大学人民医院重症监护病房收治的患者72例,根据患者的临床表现判断其有无SIRS,并根据治疗方案将患者分为治疗组41例,对照组31例。治疗组在入院后48 h内使用β受体阻滞剂,而对照组不使用β受体阻滞剂,观察两组患者在入院时和入院第3、7天APACHEⅡ评分、尿量和病死率等结果。结果两组患者在入院时和入院第3天APACHEⅡ评分差异无统计学意义(P值分别为0.945和0.124),在第7天时,治疗组的评分显著低于对照组(P=0.001)。两组入院时和入院第3天尿量/入量比值差异无统计学意义(P值分别为0.086和0.067),入院第7天治疗组尿量/入量比值显著高于对照组(P=0.006)。住院期间治疗组病死率明显低于对照组(P=0.001)。结论SIRS患者早期给予β受体阻滞剂可在入院第7天明显降低APACHEⅡ评分,改善患者症状,改善患者预后,降低病死率;而且在维持正常血压的前提下,不影响重要器官的灌注。
Objective To observe the effect of early use of β-blocker on the prognosis of patients with systemic inflammatory response syndrome (SIRS). Methods Seventy-two patients admitted to ICU of Peking University People’s Hospital from January to December in 2011 were enrolled in this study. According to the clinical manifestations of the patients, 72 patients were divided into treatment group (41 cases) and control group (31 cases). The treatment group received β-blocker within 48 h after admission, while the control group did not use β-blocker. The APACHEⅡscore, urine output and mortality of both groups were observed at admission and on the 3rd and 7th day after admission Other results. Results There was no significant difference in APACHEⅡscore between the two groups on admission and on admission day 3 (P = 0.945 and 0.124, respectively). On the seventh day, the score of the treatment group was significantly lower than that of the control group (P = 0.001). There were no significant differences in urine output / volume ratio between the two groups on admission and on the third day after admission (P = 0.086 and 0.067, respectively). On the seventh day after admission, the urine output / volume ratio in the treatment group was significantly higher than that in the control group (P = 0.006). The mortality of the treatment group during hospitalization was significantly lower than that of the control group (P = 0.001). Conclusion Early administration of β-blockers in patients with SIRS can significantly reduce the APACHEⅡ score on the 7th day of admission, improve the symptoms of patients, improve the prognosis of patients and reduce the mortality. In addition, the maintenance of normal blood pressure does not affect the perfusion of vital organs.