Hart David W, Wolf Steven E, Chinkes David L, Lal Sofia O, Ramzy Peter I, Herndon David N
Department of Surgery, The University of Texas Medical Branch, Shriners Hospitals for Children, Galveston, Texas 77550, USA.
Ann Surg. 2002 Oct;236(4):450-6; discussion 456-7. doi: 10.1097/00000658-200210000-00007.
To determine whether propranolol and growth hormone (GH) have additive effects to combat burn-induced catabolism.
Both GH and propranolol have been attributed anabolic properties after severe trauma and burn. It is conceivable that the two in combination would have additive effects.
Fifty-six children with more than 40% TBSA burns were randomized to one of four anabolic regimens: untreated control, GH treatment, propranolol treatment, or combination GH plus propranolol therapy. Clinical treatment was identical for all groups. Resting energy expenditure was determined by indirect calorimetry and skeletal muscle protein kinetics were measured using stable amino acid isotope infusions before and after each anabolic regimen.
There were no differences in age, sex, or burn size between groups. Tachycardia and energy expenditure were decreased during propranolol treatment ( <.05). The net balance of muscle protein synthesis and breakdown was improved during propranolol and GH plus propranolol treatment ( <.05). There was no significant benefit of GH alone. No additive effect of combination therapy was seen.
Propranolol is a strongly anabolic drug during the early, hypercatabolic period after burn. No synergistic effect between propranolol and GH was identified.
确定普萘洛尔和生长激素（GH）对对抗烧伤引起的分解代谢是否具有相加作用。
GH和普萘洛尔在严重创伤和烧伤后均具有合成代谢特性。可以想象，两者联合使用会产生相加作用。
56名烧伤面积超过40%体表面积的儿童被随机分为四种合成代谢方案之一：未治疗的对照组、GH治疗组、普萘洛尔治疗组或GH加普萘洛尔联合治疗组。所有组的临床治疗相同。通过间接测热法测定静息能量消耗，并在每种合成代谢方案前后使用稳定氨基酸同位素输注测量骨骼肌蛋白质动力学。
各组之间在年龄、性别或烧伤面积方面无差异。普萘洛尔治疗期间心动过速和能量消耗降低（P<.05）。普萘洛尔以及GH加普萘洛尔治疗期间肌肉蛋白质合成与分解的净平衡得到改善（P<.05）。单独使用GH无显著益处。联合治疗未见相加作用。
普萘洛尔在烧伤后的早期高分解代谢期是一种强效的合成代谢药物。未发现普萘洛尔与GH之间有协同作用。
