Objective: To study the clinical effect and mechanism of action of esmolol in the treatment of severe hand, foot, and mouth disease (HFMD).
Methods: A prospective randomized controlled trial was performed. A total of 102 children with severe HFMD were enrolled in the study and were randomly divided into conventional treatment and esmolol treatment groups (n=51 each). The children in the conventional treatment group were given conventional treatment according to the guidelines for the diagnosis and treatment of HFMD. Those in the esmolol treatment group were given esmolol in addition to the conventional treatment. The heart rate (HR), systolic blood pressure (SBP), and respiratory rate (RR) were continuously monitored for all children. Blood samples were collected from all children before treatment and 1, 3, and 5 days after treatment to measure the levels of norepinephrine (NE), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and nuclear factor-kappa B (NF-κB) p65 in mononuclear cells. Serum levels of myocardial enzymes and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured before treatment and after 5 days of treatment.
Results: There were no significant differences in HR, SBP, RR, NE, TNF-α, IL-6, NF-κB p65, serum myocardial enzymes, and NT-proBNP before treatment between the conventional treatment and esmolol treatment groups. Both groups had significant reductions in these parameters at each time point (P<0.05). Compared with the conventional treatment group, the esmolol treatment group had significant improvements in the above parameters after 1 and 3 days of treatment (P<0.05). After 5 days of treatment, the esmolol treatment group had significant improvements in serum levels of myocardial enzymes and NT-proBNP compared with the conventional treatment group (P<0.05).
Conclusions: Early application of esmolol can effectively stabilize the vital signs of the children with severe HFMD. Its mechanism of action may be related to reducing serum catecholamine concentration, alleviating myocardial damage, improving cardiac function, and reducing inflammatory response.
目的: 探讨艾司洛尔治疗危重型手足口病（HFMD）的临床疗效其作用机制。
方法: 102例危重型HFMD患儿随机分为常规治疗组和艾司洛尔组，每组51例患儿。常规治疗组按照HFMD诊疗指南予以常规治疗，艾司洛尔组在常规治疗组基础上加用艾司洛尔。两组患儿均持续监测心率（HR）、收缩压（SBP）、呼吸频率（RR）。两组患儿分别于治疗前及治疗后1 d、3 d、5 d采血检测外周血去甲肾上腺素（NE）、肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）及单核细胞NF-κB p65含量。在治疗前和治疗5 d后采血检测血清心肌酶及氨基末端脑钠肽前体（NT-proBNP）的水平。
结果: 治疗前两组患儿HR、SBP、RR、NE、TNF-α、IL-6、NF-κB p65、心肌酶、NT-proBNP水平差异均无统计学意义。与治疗前相比，治疗后2组患儿各时间点检测的以上各指标均明显降低（P <0.05）。与常规治疗组相比，艾司洛尔组治疗1 d、3 d后上述各项指标改善更明显（P <0.05）。治疗5 d后艾司洛尔组患儿血清心肌酶和NT-proBNP水平较常规治疗组改善更显著（P <0.05）。
结论: 早期应用艾司洛尔能有效地稳定危重型HFMD患儿生命体征，其可能的作用机制为降低血清儿茶酚胺浓度，减轻心肌损伤，改善心功能，减轻炎性反应。