Al-Mousawi Ahmed M, Williams Felicia N, Mlcak Ronald P, Jeschke Marc G, Herndon David N, Suman Oscar E
Department of Surgery, The University of Texas Medical Branch, Galveston, Texas 77550, USA.
J Burn Care Res. 2010 May-Jun;31(3):400-8. doi: 10.1097/BCR.0b013e3181db5317.
Severe burns cause profound hormonal and metabolic disturbances resulting in hypermetabolism, reflected in extreme elevation of resting energy expenditure (REE) and extensive skeletal muscle catabolism. Aerobic and resistive exercise programs during rehabilitation have shown substantial benefits, although whether such training potentially exacerbates basal metabolism is unknown. Therefore, the effects of exercise training on REE during the rehabilitation of severely burned pediatric patients were examined. Children with 40% total body surface area burns and greater were enrolled at admission to the burn intensive care unit to participate in a 12-week, hospital-based exercise program (EX) or a home-based standard of care program (SOC), commencing 6 months after injury. Twenty-one patients (aged 7-17 years) were enrolled and randomized to SOC (n = 10) or EX (n = 11). Age, sex, and total body surface area burned were similar. Mean change (+/-standard deviation) in REE, normalized to individual lean body mass, was almost negligible between SOC and EX group patients (SOC, 0.03 +/- 17.40% vs EX, 0.01 +/- 26.38%). A significant increase in lean body mass was found for EX patients (SOC, 2.06 +/- 3.17% vs EX, 8.75 +/- 5.65%; P = .004), which persisted when normalized to height (SOC, 0.70 +/- 2.39% vs EX, 6.14 +/- 6.46%; P = .02). Peak torque also improved significantly more in EX patients (SOC, 12.29 +/- 16.49% vs EX, 54.31 +/- 44.25%; P = .02), reflecting improved strength. Exercise training significantly enhanced lean mass and strength, without observed exacerbation of postburn hypermetabolism. Therefore, the use of exercise conditioning as a safe and effective component of pediatric burn rehabilitation is advocated.
严重烧伤会导致深刻的激素和代谢紊乱，进而引发高代谢，这表现为静息能量消耗（REE）极度升高以及广泛的骨骼肌分解代谢。康复期间的有氧和抗阻运动计划已显示出显著益处，尽管这种训练是否会潜在地加剧基础代谢尚不清楚。因此，研究了运动训练对严重烧伤儿科患者康复期间REE的影响。烧伤总面积达40%及以上的儿童在入院进入烧伤重症监护病房时被纳入研究，参与一项为期12周的基于医院的运动计划（EX）或基于家庭的标准护理计划（SOC），该计划在受伤6个月后开始。21名患者（年龄7 - 17岁）被纳入并随机分为SOC组（n = 10）或EX组（n = 11）。年龄、性别和烧伤总面积相似。以个体瘦体重进行标准化后，SOC组和EX组患者REE的平均变化（±标准差）几乎可以忽略不计（SOC组为0.03 ± 17.40%，EX组为0.01 ± 26.38%）。发现EX组患者的瘦体重显著增加（SOC组为2.06 ± 3.17%，EX组为8.75 ± 5.65%；P = 0.004），以身高进行标准化后该差异依然存在（SOC组为0.70 ± 2.39%，EX组为6.14 ± 6.46%；P = 0.02）。EX组患者的峰值扭矩也显著改善得更多（SOC组为12.29 ± 16.49%，EX组为54.31 ± 44.25%；P = 0.02），这反映了力量的增强。运动训练显著增强了瘦体重和力量，且未观察到烧伤后高代谢加剧。因此，提倡将运动调节作为儿科烧伤康复安全有效的组成部分。
