Guillory Ashley N, Herndon David N, Silva Michael B, Andersen Clark R, Edgu-Fry Erge, Suman Oscar E, Finnerty Celeste C
Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Institute for Translational Sciences and Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States.
Department of Surgery, University of Texas Medical Branch, Galveston, TX, United States; Shriners Hospitals for Children(®) - Galveston, Galveston, TX, United States.
Burns. 2017 Sep;43(6):1168-1174. doi: 10.1016/j.burns.2016.10.019. Epub 2017 Jun 20.
The aim of this study was to determine the appropriate propranolol dosing strategy for reducing heart rate in severely burned adults.
A total of 26 patients (≥18 years) with burns covering ≥30% of the total body surface area were included in this IRB-approved study. Plasma propranolol concentrations were determined in a placebo group (n=10) or following one of three dosing strategies: Q6 (n=4), Q8 (n=6), and Q24 (n=6). Blood was collected just before dosing and at regular intervals over two dosing periods with corresponding heart rate and blood pressure recordings. Statistical significance was determined by one-way ANOVA followed by the appropriate post-hoc test.
Heart rate was 86±2 bpm for Q6, 93±3 bpm for Q8, and 90±4 bpm for Q24. The Q8 group had a significantly higher heart rate than the Q6 group (p=0.0001). Plasma propranolol concentrations were significantly higher in the Q6 dosing strategy than in the Q8 dosing strategy (p=0.02).
Heart rate can be decreased to a similar degree with Q6 and Q24 dosing strategies, with the Q8 dosing strategy being less effective. Q6 dosing is recommended to maintain reduced heart rate throughout dosing periods.
本研究旨在确定用于降低严重烧伤成年人心率的合适的普萘洛尔给药策略。
本项经机构审查委员会批准的研究纳入了26例年龄≥18岁、烧伤面积≥全身表面积30%的患者。在安慰剂组（n = 10）或三种给药策略之一后测定血浆普萘洛尔浓度：每6小时一次（n = 4）、每8小时一次（n = 6）和每24小时一次（n = 6）。在给药前以及在两个给药期间定期采集血液，并记录相应的心率和血压。通过单因素方差分析及适当的事后检验确定统计学显著性。
每6小时一次给药策略组的心率为86±2次/分钟，每8小时一次给药策略组为93±3次/分钟，每24小时一次给药策略组为90±4次/分钟。每8小时一次给药策略组的心率显著高于每6小时一次给药策略组（p = 0.0001）。每6小时一次给药策略的血浆普萘洛尔浓度显著高于每8小时一次给药策略（p = 0.02）。
每6小时一次和每24小时一次给药策略可使心率降低至相似程度，每８小时一次给药策略效果较差。建议采用每6小时一次给药策略以在整个给药期间维持心率降低。
