Herndon David N, Voigt Charles D, Capek Karel D, Wurzer Paul, Guillory Ashley, Kline Andrea, Andersen Clark R, Klein Gordon L, Tompkins Ronald G, Suman Oscar E, Finnerty Celeste C, Meyer Walter J, Sousse Linda E
*Department of Surgery †Institute for Translational Sciences, University of Texas Medical Branch ‡Shriners Hospital for Children-Galveston, Galveston, TX §Division of Plastic Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria ¶Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston ||Department of Surgery, Massachusetts General Hospital, Boston, MA **Sealy Center for Molecular Medicine ††Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Galveston.
Ann Surg. 2016 Sep;264(3):421-8. doi: 10.1097/SLA.0000000000001844.
The hypercatabolic response in severely burned pediatric patients is associated with increased production of catecholamines and corticosteroids, decreased formation of testosterone, and reduced strength alongside growth arrest for up to 2 years after injury. We have previously shown that, in the pediatric burned population, the administration of the testosterone analog oxandrolone improves lean body mass accretion and bone mineral content and that the administration of the β1-, β2-adrenoceptor antagonist propranolol decreases cardiac work and resting energy expenditure while increasing peripheral lean mass. Here, we determined whether the combined administration of oxandrolone and propranolol has added benefit.
In this prospective, randomized study of 612 burned children [52% ± 1% of total body surface area burned, ages 0.5-14 years (boys); ages 0.5-12 years (girls)], we compared controls to the individual administration of these drugs, and the combined administration of oxandrolone and propranolol at the same doses, for 1 year after burn. Data were recorded at discharge, 6 months, and 1 and 2 years after injury.
Combined use of oxandrolone and propranolol shortened the period of growth arrest by 84 days (P = 0.0125 vs control) and increased growth rate by 1.7 cm/yr (P = 0.0024 vs control).
Combined administration of oxandrolone and propranolol attenuates burn-induced growth arrest in pediatric burn patients. The present study is registered at clinicaltrials.gov: NCT00675714 and NCT00239668.
严重烧伤的儿科患者的高分解代谢反应与儿茶酚胺和皮质类固醇生成增加、睾酮生成减少以及受伤后长达2年的生长停滞伴力量减弱有关。我们之前已经表明，在儿科烧伤人群中，给予睾酮类似物氧雄龙可改善瘦体重增加和骨矿物质含量，给予β1、β2肾上腺素能受体拮抗剂普萘洛尔可减少心脏做功和静息能量消耗，同时增加外周瘦体重。在此，我们确定氧雄龙和普萘洛尔联合给药是否有额外益处。
在这项对612名烧伤儿童[烧伤总面积为52%±1%，年龄0.5 - 14岁（男孩）；0.5 - 12岁（女孩）]进行的前瞻性随机研究中，我们将对照组与这些药物单独给药以及相同剂量的氧雄龙和普萘洛尔联合给药进行比较，观察烧伤后1年的情况。在出院时、受伤后6个月、1年和2年记录数据。
氧雄龙和普萘洛尔联合使用使生长停滞期缩短了84天（与对照组相比，P = 0.0125），生长速率提高了1.7厘米/年（与对照组相比，P = 0.0024）。
氧雄龙和普萘洛尔联合给药可减轻儿科烧伤患者烧伤诱导的生长停滞。本研究已在clinicaltrials.gov注册：NCT00675714和NCT00239668。
