Childs C, Heath D F, Little R A, Brotherston M
NWIRC (MRC Trauma Group), University of Manchester, U.K.
Arch Emerg Med. 1990 Sep;7(3):135-47. doi: 10.1136/emj.7.3.135.
Plasma and blood metabolites were measured in 31 children over the first day after burn injury. In 14 of them blood glucose peaked, rising within 1-4h to 10-20 mmol/l and then falling, by 4-8 h, to 5-10 mmol/l. Usually the peak value preceded treatment and the fall occurred during infusion of dextrose-saline. Peak incidence was independent of burn severity. There was no evidence of similar peaks in children or adults with other injuries, or in 8 adults with burn injuries; through high glucose levels have been reported in children with head injuries. Lactate, non-esterified fatty acids, insulin, cortisol, epinephrine and norepinephrine were also measured. Values in the first 4 h were similar to those reported in adults with other injuries, except for lactate, which rose less in the children. Unexpectedly, the hyperglycemia in the children with burns was poorly related to epinephrine concentration at all times to 24h. Insulin resistance probably developed within the first hour or two; but from 8 h did not seem to depend on synergism between epinephrine and cortisol.
在烧伤后的第一天对31名儿童的血浆和血液代谢物进行了测量。其中14名儿童的血糖达到峰值，在1 - 4小时内升至10 - 20毫摩尔/升，然后在4 - 8小时降至5 - 10毫摩尔/升。通常峰值出现在治疗前，下降发生在输注葡萄糖盐水期间。峰值发生率与烧伤严重程度无关。在患有其他损伤的儿童或成人中，以及在8名烧伤成人中，均未发现类似的峰值；不过有报道称头部受伤的儿童血糖水平较高。还测量了乳酸、非酯化脂肪酸、胰岛素、皮质醇、肾上腺素和去甲肾上腺素。前4小时的值与患有其他损伤的成人报告的值相似，但乳酸除外，儿童的乳酸升高幅度较小。出乎意料的是，烧伤儿童的高血糖在24小时内的任何时候都与肾上腺素浓度关系不大。胰岛素抵抗可能在最初的一两个小时内就已出现；但从8小时起似乎并不依赖于肾上腺素和皮质醇之间的协同作用。
