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在儿童的中性和热环境下,β-肾上腺素能阻滞剂不会损害烧伤皮肤和未烧伤皮肤对局部加热的皮肤血流敏感性。

β-Adrenergic blockade does not impair the skin blood flow sensitivity to local heating in burned and nonburned skin under neutral and hot environments in children.

作者信息

Rivas Eric, McEntire Serina J, Herndon David N, Mlcak Ronald P, Suman Oscar E

机构信息

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.

出版信息

Microcirculation. 2017 May;24(4). doi: 10.1111/micc.12350.

Abstract

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

Therapeutic propranolol does not negatively affect SkBF under neutral or hot environmental conditions and further compromise temperature regulation in burned children.

摘要

目的

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。

方法

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。

结果

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)。

结论

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。

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