Objective To analyze the protective effect of esmolol combined with early goal-directed therapy on myocardial function in patients with severe sepsis. Methods The clinical data of patients with severe sepsis who were treated in our hospital were retrospectively analyzed. According to the principles of randomization, balance and control, 30 cases receiving esmolol combined with early goal-directed therapy were selected as the observation group. The other 30 cases who were given early goal-directed therapy during the same period were selected as the control group. The effects of the two treatment regimens on the levels of hemodynamic indices, cTnT, BNP, TNF-a, IL-1β, Lac, central venous oxygen saturation(ScvO2) and other indices were compared, and 28-day survival rate was statistically analyzed. Results After treatment, Ea/Aa in the observation group was increased significantly, and HRwas decreased significantly. Only HRwas decreased significantly in the control group. There was no statistically significant difference within groups and between the two groups in other hemodynamic indices (P＞0. 05); the levels of cTnT, BNP, TNF-a, and IL-1β in both groups were significantly decreased and the observation group was lower than the control group. The differences within groups and between groups were statistically significant; the serum Lac was decreased and ScvO2 was increased in both groups. The serum Lac in the observation group was lower than that in the control group, and ScvO2 was higher than that in the control group. There were statistically significant differences within groups and between groups (P＜0. 05); the survival rate in the observation group was slightly higher than that in the control group, but the difference was not statistically significant(χ2=0. 480, P=0. 488). Conclusion Esmolol combined with early goal-directed therapy may benefit myocardial protection in patients with severe sepsis.

Sepsis is the main cause of infection death in intensive care unit(ICU),and thrombocytopenia is a common complication.Persistent thrombocytopenia is a marker of poor prognosis in critically ill patients.Sepsis-associated thrombocytopenia(SAT)involves a variety of pathophysiological mechanisms,and platelets play a key role in coagulation and inflammatory response.Platelet count(PLT)can not only predict the prognosis of patients with sepsis,but also be used as a therapeutic target to improve the success rate of rescue in patients with sepsis.This article will review the pathophysiological mechanism,prognosis and treatment of platelets in septic patients.

Objective:To evaluate the prognostic value of sepsis-induced coagulopathy (SIC) in patients with sepsis.Methods:From January 2019 to December 2021, patients with sepsis admitted to the Intensive Care Unit of our hospital were retrospectively classified into the SIC group and non-SIC group according to SIC diagnostic criteria. The baseline clinical data, severity score, total length of hospital stay, length of ICU stay and 28-day survival were compared between the two groups. Kaplan-Meier was used to compare the 28-day survival of patients with sepsis between the two groups. Cox proportional hazard regression model was employed to analyze the risk factors of prognosis in patients with sepsis.Results:Totally 274 patients with sepsis were included in the analysis, including 139 patients in the SIC group and 135 patients in the non-SIC group. The two groups were compared in the perspectives of the Platelet count (PLT), prothrombin time (PT) , procalcitonin (PCT), D dimer, hematocrit, red blood cell distribution width, hemoglobin, acute kidney injury (AKI), the use of continuous renal replacement treatment (CRRT), the use of vasoactive drugs, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHEⅡ) score were compared between the two groups and the difference were statistically different (all P<0.05). Kaplan-Meier analysis showed that the 28-day mortality rate in the SIC group was significantly higher than that in the non-SIC group (32.4% vs. 14.1%, P<0.05). COX proportional hazard model showed that SIC score ( HR= 2.17, 95% CI: 1.15-3.91, P<0.05), APACHEⅡ score ( HR= 1.13, 95% CI: 1.09-1.17, P<0.05) and the use of vasoactive drugs ( HR=3.66, 95% CI: 1.53-8.75, P<0.05) were independent influencing factors for 28-day death in patients with sepsis. Conclusions:Patients with sepsis and SIC have more severe disease and increased mortality risk. SIC score exhibits good clinical value in predicting the prognosis of patients with sepsis.