Rivas Eric, McEntire Serina J, Herndon David N, Mlcak Ronald P, Suman Oscar E
Shriners Hospitals for Children, The University of Texas Medical Branch, Galveston, TX, USA.
Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
Microcirculation. 2017 May;24(4). doi: 10.1111/micc.12350.
We tested the hypothesis that propranolol, a drug given to burn patients to reduce hypermetabolism/cardiac stress, may inhibit heat dissipation by changing the sensitivity of skin blood flow (SkBF) to local heating under neutral and hot conditions.
In a randomized double-blind study, a placebo was given to eight burned children, while propranolol was given to 13 burned children with similar characteristics (mean±SD: 11.9±3 years, 147±20 cm, 45±23 kg, 56±12% Total body surface area burned). Nonburned children (n=13, 11.4±3 years, 152±15 cm, 52±13 kg) served as healthy controls. A progressive local heating protocol characterized SkBF responses in burned and unburned skin and nonburned control skin under the two environmental conditions (23 and 34°C) via laser Doppler flowmetry.
Resting SkBF was greater in burned and unburned skin compared to the nonburned control (main effect: skin, P<.0001; 57±32 burned; 38±36 unburned vs 9±8 control %SkBF ). No difference was found for maximal SkBF capacity to local heating between groups. Additionally, dose-response curves for the sensitivity of SkBF to local heating were not different among burned or unburned skin, and nonburned control skin (EC , P>.05) under either condition.
Therapeutic propranolol does not negatively affect SkBF under neutral or hot environmental conditions and further compromise temperature regulation in burned children.
我们检验了这样一个假设,即给烧伤患者使用普萘洛尔以降低高代谢/心脏应激,可能会通过改变皮肤血流量(SkBF)在中性和热环境条件下对局部加热的敏感性来抑制散热。
在一项随机双盲研究中,给8名烧伤儿童服用安慰剂,而给13名具有相似特征(平均±标准差:11.9±3岁,147±20厘米,45±23千克,56±12%体表面积烧伤)的烧伤儿童服用普萘洛尔。未烧伤儿童(n = 13,11.4±3岁,152±15厘米,52±13千克)作为健康对照。通过激光多普勒血流仪,采用渐进性局部加热方案来表征在两种环境条件(23和(34^{\circ}C))下烧伤皮肤、未烧伤皮肤和未烧伤对照皮肤的SkBF反应。
与未烧伤对照相比,烧伤皮肤和未烧伤皮肤的静息SkBF更高(主要效应:皮肤,P <.0001;烧伤皮肤为57±32,未烧伤皮肤为38±36,对照皮肤为9±8%SkBF)。各组之间局部加热的最大SkBF容量没有差异。此外,在任何一种条件下,烧伤或未烧伤皮肤以及未烧伤对照皮肤中SkBF对局部加热敏感性的剂量反应曲线没有差异((EC_{50}),P >.05)。
治疗剂量的普萘洛尔在中性或热环境条件下不会对SkBF产生负面影响,也不会进一步损害烧伤儿童的体温调节。