Tapking Christian, Popp Daniel, Herndon David N, Branski Ludwik K, Mlcak Ronald P, Suman Oscar E
Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA; Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Germany.
Department of Surgery, University of Texas Medical Branch and Shriners Hospitals for Children(®)-Galveston, 815 Market Street, Galveston, TX 77550, USA; Division of Hand, Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Burns. 2018 Dec;44(8):2026-2033. doi: 10.1016/j.burns.2018.06.004. Epub 2018 Jul 10.
In burned children, exercise training increases maximal oxygen consumption (VO max) and can be combined with the nonspecific beta-blocker propranolol to decrease cardiac work. VO max is estimated if indirect calorimetry is not available. We compared measured and estimated VO max in severely burned children treated with or without propranolol to determine the suitability of commonly used formulas in these populations.
Patients received propranolol or placebo (control) during acute hospitalization. VO max was measured during a modified Bruce treadmill test at discharge and compared to values obtained using the Cooper, Bruce, American College of Sports Medicine, and Porro formulas. Pearson correlations and Bland-Altman analyses were used to compare measured and estimated values.
Ninety-nine children (propranolol n=46,control n=53) admitted at our facility between 2003 and 2016 were analyzed. Age at burn (propranolol 12±4years, control 12±3years,p=0.893) and total body surface area burned (propranolol 44±15%,control 49±14%,p=0.090) were comparable between groups. Measured VO max was higher in the propranolol group (25.5±6.0mL/min/kg vs. 22.0±4.7mL/min/kg,p=0.002) and was generally lower than estimated values. Age, sex, inhalation injury, body mass index, exercise time, and maximal speed were predictive of measured VO max in the control group. Age, sex, and maximal speed were predictive in the propranolol group. Backward selection yielded the formula [7.63+ 2.16×sex(females=0,males=1)+0.41×age(years)+0.15×maximal speed(m/min)] (R=0.6525).
Propranolol seems to have beneficial effects on cardiorespiratory capacity in burned children. However, estimated VO max with common formulas were too high. The VO max formula reported here is suitable for propranolol-treated children and the Porro formula for non-propranolol-treated children.
在烧伤儿童中，运动训练可增加最大耗氧量（VO₂max），并且可与非特异性β受体阻滞剂普萘洛尔联合使用以降低心脏负荷。若无法进行间接测热法，则估算VO₂max。我们比较了接受或未接受普萘洛尔治疗的重度烧伤儿童的实测VO₂max和估算VO₂max，以确定常用公式在这些人群中的适用性。
患者在急性住院期间接受普萘洛尔或安慰剂（对照）治疗。出院时在改良的布鲁斯跑步机测试中测量VO₂max，并与使用库珀公式、布鲁斯公式、美国运动医学学院公式和波罗公式获得的值进行比较。采用Pearson相关性分析和Bland-Altman分析来比较实测值和估算值。
对2003年至2016年间在我们机构收治的99名儿童（普萘洛尔组n = 46，对照组n = 53）进行了分析。两组间烧伤时的年龄（普萘洛尔组12±4岁，对照组12±3岁，p = 0.893）和烧伤总面积（普萘洛尔组44±15%，对照组49±14%，p = 0.090）具有可比性。普萘洛尔组的实测VO₂max较高（25.5±6.0mL/min/kg对22.0±4.7mL/min/kg，p = 0.002），且通常低于估算值。年龄、性别、吸入性损伤、体重指数、运动时间和最大速度可预测对照组的实测VO₂max。年龄、性别和最大速度可预测普萘洛尔组的实测VO₂max。向后选择得出公式[7.63 + 2.16×性别（女性=0，男性=1）+ 0.41×年龄（岁）+ 0.15×最大速度（米/分钟）]（R = 0.6525）。
普萘洛尔似乎对烧伤儿童的心肺功能有有益影响。然而，常用公式估算的VO₂max过高。本文报道的VO₂max公式适用于接受普萘洛尔治疗的儿童，而波罗公式适用于未接受普萘洛尔治疗的儿童。
