Ali Arham, Herndon David N, Mamachen Ashish, Hasan Samir, Andersen Clark R, Grogans Ro-Jon, Brewer Jordan L, Lee Jong O, Heffernan Jamie, Suman Oscar E, Finnerty Celeste C
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX, 77555, USA.
Shriners Hospitals for Children, 815 Market Street, Galveston, TX, 77550, USA.
Crit Care. 2015 May 4;19(1):217. doi: 10.1186/s13054-015-0913-x.
Propranolol, a nonselective β-blocker, exerts an indirect effect on the vasculature by leaving α-adrenergic receptors unopposed, resulting in peripheral vasoconstriction. We have previously shown that propranolol diminishes peripheral blood following burn injury by increasing vascular resistance. The purpose of this study was to investigate whether wound healing and perioperative hemodynamics are affected by propranolol administration in severely burned adults.
Sixty-nine adult patients with burns covering ≥ 30% of the total body surface area (TBSA) were enrolled in this IRB-approved study. Patients received standard burn care with (n = 35) or without (control, n = 34) propranolol. Propranolol was administered within 48 hours of burns and given throughout hospital discharge to decrease heart rate by approximately 20% from admission levels. Wound healing was determined by comparing the time between grafting procedures. Blood loss was determined by comparing pre- and postoperative hematocrit while factoring in operative graft area. Data were collected between first admission and first discharge.
Demographics, burn size, and mortality were comparable in the control and propranolol groups. Patients in the propranolol group received an average propranolol dose of 3.3 ± 3.0 mg/kg/day. Daily average heart rate over the first 30 days was significantly lower in the propranolol group (P < 0.05). The average number of days between skin grafting procedures was also lower in propranolol patients (10 ± 5 days) than in control patients (17 ± 12 days; P = 0.02), indicative of a faster donor site healing time in the propranolol group. Packed red blood cell infusion was similar between groups (control 5.3 ± 5.4 units vs. propranolol 4.4 ± 3.1 units, P = 0.89). Propranolol was associated with a 5 to 7% improvement in perioperative hematocrit during grafting procedures of 4,000 to 16,000 cm(2) compared to control (P = 0.002).
Administration of propranolol during the acute hospitalization period diminishes blood loss during skin grafting procedures and markedly improves wound healing in severely burned adults. As burn patients require serial surgical interventions for motor and cosmetic repair, restricting blood loss during operative intervention is optimal.
普萘洛尔是一种非选择性β受体阻滞剂，通过使α肾上腺素能受体失去拮抗作用而对血管系统产生间接影响，导致外周血管收缩。我们之前已经表明，普萘洛尔通过增加血管阻力来减少烧伤后的外周血容量。本研究的目的是调查在严重烧伤的成年人中，给予普萘洛尔是否会影响伤口愈合和围手术期血流动力学。
69例烧伤面积占全身表面积（TBSA）≥30%的成年患者纳入了这项经机构审查委员会批准的研究。患者接受标准烧伤护理，其中35例患者使用普萘洛尔（治疗组），34例患者不使用普萘洛尔（对照组）。普萘洛尔在烧伤后48小时内给药，并持续至出院，以使心率从入院时的水平降低约20%。通过比较植皮手术之间的时间来确定伤口愈合情况。通过比较术前和术后的血细胞比容，并考虑手术植皮面积来确定失血量。数据收集自首次入院至首次出院期间。
对照组和普萘洛尔组在人口统计学、烧伤面积和死亡率方面具有可比性。普萘洛尔组患者的普萘洛尔平均剂量为3.3±3.0mg/kg/天。普萘洛尔组在前30天的每日平均心率显著较低（P<0.05）。普萘洛尔组患者进行皮肤移植手术之间的平均天数（10±5天）也低于对照组患者（17±12天；P=0.02），这表明普萘洛尔组供皮区愈合时间更快。两组之间的浓缩红细胞输注量相似（对照组5.3±5.4单位，普萘洛尔组4.4±3.1单位，P=0.89）。与对照组相比，在4000至16000cm²的植皮手术期间，普萘洛尔使围手术期血细胞比容提高了5%至7%（P=0.002）。
在急性住院期间给予普萘洛尔可减少严重烧伤成年人植皮手术期间的失血量，并显著改善伤口愈合。由于烧伤患者需要进行一系列手术干预以进行运动和美容修复，因此在手术干预期间限制失血量是最佳选择。
