Honeycutt D, Barrow R, Herndon D
Shriners Burns Institute, Galveston, TX 77550.
J Burn Care Rehabil. 1992 Mar-Apr;13(2 Pt 1):181-6. doi: 10.1097/00004630-199203000-00001.
Adrenergic receptor blockade has been shown to be of benefit in the treatment of adverse cardiovascular changes in patients with burns during the hypermetabolic phase. This article examines the stress response to cold exposure in adults and children with 33% to 95% total body surface area burns with and without beta-blockade. Resting energy expenditures were measured by indirect calorimetry; the test subjects were exposed to mean temperatures of 27.5 degrees C (room temperature) or 24.6 degrees C (cold). The mean resting energy expenditure at ambient room temperature in patients with burns without beta-blockade was 1411 +/- 70 kcal/m2/day (mean +/- SEM). This value was 142% of that predicted for normal control subjects without burns. When placed in a cold temperature, patients with burns significantly increased their resting energy expenditures by 160% of predicted values, whereas patients with similar burns and beta-blockade increased their resting energy expenditures by 156%. Adults with septic burns had a mean resting energy expenditure 198% of the predicted value. These patients did not significantly increase their resting energy expenditures when they were exposed to cold either with or without beta-blockade. Data suggest that patients with septic burns already have a maximal metabolic response and that cold stress does not further increase this response. Males, ages 17 to 54 years, were found to increase their resting energy expenditures by 11.4 kcal/m2/day for each percent total body surface area burn. We conclude that beta-blockade with propranolol in therapeutic doses may be used in patients with burns without adversely affecting the cold stress response.
肾上腺素能受体阻滞剂已被证明有助于治疗烧伤患者在高代谢阶段出现的不良心血管变化。本文研究了全身表面积烧伤33%至95%的成人和儿童在有或没有β受体阻滞剂的情况下对冷暴露的应激反应。通过间接测热法测量静息能量消耗；测试对象暴露于27.5摄氏度（室温）或24.6摄氏度（寒冷）的平均温度下。未使用β受体阻滞剂的烧伤患者在室温环境下的平均静息能量消耗为1411±70千卡/平方米/天（平均值±标准误）。该值是未烧伤正常对照受试者预测值的142%。当置于寒冷环境中时，烧伤患者的静息能量消耗显著增加，达到预测值的160%，而有类似烧伤且使用β受体阻滞剂的患者静息能量消耗增加了156%。患有败血症性烧伤的成年人平均静息能量消耗为预测值的198%。无论是否使用β受体阻滞剂，这些患者在暴露于寒冷环境时静息能量消耗均未显著增加。数据表明，患有败血症性烧伤的患者已经有最大的代谢反应，冷应激不会进一步增加这种反应。发现17至54岁的男性，每烧伤全身表面积1%，其静息能量消耗增加11.4千卡/平方米/天。我们得出结论，治疗剂量的普萘洛尔β受体阻滞剂可用于烧伤患者，而不会对冷应激反应产生不利影响。
