Effects of esmolol combined with levosimendan on cardiac function in patients with severe sepsis

Abstract

Objective To observe the effect of esmolol combined with levosimendan on cardiac function in patients with severe sepsis and explore its possible mechanism. Methods Seventy-three patients with severe sepsis by early goal-directed therapy (EGDT) after the heart rate more than 95 times/min were randomly divided into control group (group C), levosimendan group (group Z) and esmolol combined levosimendan (group ZA). Group C according to the sepsis guidelines for early goal-directed therapy (EGDT), at the same time, the application of norepinephrine to maintain the mean arterial pressure (MAP) was more than 65 mmHg(1 mmHg=0.133 kPa), Milrinone injection 10 mg with 0.9% sodium chloride injection 40 ml, with 0.4-0.6 g/(kg·min) micro pump intravenous infusion for 48 h. In group Z, Milrinone injection was converted to levosimendan by continuous intravenous infusion of 0.2 μg/(kg·min) 24 h based on the treatment of group C; in group ZA, on the basis of group Z, intravenous continuous infusion of esmolol 0.05 to 0.30 mg/(kg·min) was carried out, and the heart rate of patients was controlled at 75-94 times/min. The levels of MAP, central venous pressure (CVP), heart rate (HR), lactic acid (Lac), BNP, CK-MB and Tropnin I were measured before and 24 h, 48 h, 72 h, 96 h after treatment in the three groups. Results Before treatment, there was no significant difference in the levels of MAP, CVP, HR, Lac, BNP, CK-MB or Tropnin I among the three groups, there was no significant difference in MAP and CVP among the three groups before and after treatment; at the same time after treatment, BNP, CK-MB, Tropnin I and Lac in group Z were significantly lower than those in group C (P<0.05); at the same time after treatment, the levels of HR, BNP, CK-MB and Lac in group ZA were significantly lower than those in group Z(P<0.05), Tropnin I level was significantly lower than that in group Z(P<0.01); after treatment, group Z compared with group C, group ZA compared with group Z: the number of days in hospital decreased significantly (P<0.05), the cure number increased significantly (P<0.05), and the death number decreased significantly (P<0.05). Conclusions Esmolol combined with levosimendan can significantly improve the cardiac function in patients with severe sepsis, and reduce the average hospitalization days and mortality, and improve the cure rate of patients. Key words: Esmolol; Levosimendan; Sepsis; Cardiac function