title: [Application of esmolol in severe hand, foot, and mouth disease].
abstract: 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.
authors.affiliation: Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China. xuzhoupicu@163.com.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhu
authors.forename: Bo-Xiang
authors.initials: BX
authors.lastname: Qi
authors.forename: Dai-Hua
authors.initials: DH
authors.lastname: Fang
authors.forename: Gong-Jian
authors.initials: GJ
authors.lastname: Qi
authors.forename: Kun
authors.initials: K
authors.lastname: Gao
authors.forename: Bao-Li
authors.initials: BL
authors.lastname: Hu
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011412:Propanolamines / Q000494:pharmacology / Q000627:therapeutic use*; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; C508600:IL6 protein, human; D015850:Interleukin-6; D010446:Peptide Fragments; D011412:Propanolamines; D014409:Tumor Necrosis Factor-alpha; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; C036604:esmolol