Propranolol and Oxandrolone Therapy Accelerated Muscle Recovery in Burned Children.
Propranolol and Oxandrolone Therapy Accelerated Muscle Recovery in Burned Children.
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DOI：
10.1249/mss.0000000000001459
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发表时间：
2018-03
影响因子：
4.1
通讯作者：
Suman OE
中科院分区：
文献类型：
--
作者：
Chao T;Porter C;Herndon DN;Siopi A;Ideker H;Mlcak RP;Sidossis LS;Suman OE
严重烧伤导致长期高代谢和骨骼肌痉挛。反射性运动训练（RET）计划改善了严重烧伤儿童的肌肉质量和力量。RET与β-阻滞剂或睾酮类似物的组合显示出对身体组成和肌肉功能的运动诱导益处的改善。然而，RET联合多种药物治疗对肌肉质量、力量、心肺适应性和蛋白质周转的影响尚不清楚。在这项安慰剂对照随机试验中，我们假设与安慰剂进行相同RET的烧伤儿童相比，RET与氧甲氢龙和普萘洛尔（Oxprop）联合使用将改善严重烧伤儿童的肌肉质量和功能以及蛋白质周转。我们研究了42名严重烧伤儿童（7 - 17岁），严重烧伤超过总体表面积的30%。患者被随机分配到安慰剂组（22名对照组）或Oxprop组，并在入院后96小时内开始给药。所有患者在出院时开始RET，作为标准化护理的一部分。分别测量RET前（PRE）和RET后（POST）的肌力（N·m）、功率（W）、VO 2峰值、体成分、蛋白质合成率（FSR）和分解率（FBR）。两组的肌肉力量和功率、瘦体重和VO 2峰值均随RET的增加而增加（p<0.01）。Oxprop与对照相比，强度和功率的增加显著更大（p<0.01），并且Oxprop的强度和功率大于对照POST RET（p<0.05）。RET后Oxprop中的FSR显著高于对照（p<0.01），导致RET后蛋白质净平衡改善（p<0.05）。RET可改善严重烧伤康复儿童的身体成分、肌肉功能和心肺功能。Oxprop治疗增强RET介导的肌肉力量，功率和蛋白质周转的改善。
Severe burns result in prolonged hypermetabolism and skeletal muscle catabolism. Rehabilitative exercise training (RET) programs improved muscle mass and strength in severely burned children. The combination of RET with β-blockade or testosterone analogues showed improved exercise-induced benefits on body composition and muscle function. However, the effect of RET combined with multiple drug therapy on muscle mass, strength, cardiorespiratory fitness and protein turnover are unknown. In this placebo-controlled randomized trial, we hypothesize that RET combined with oxandrolone and propranolol (Oxprop) will improve muscle mass and function and protein turnover in severely burned children compared to burned children undergoing the same RET with a placebo. We studied 42 severely burned children (7 – 17 years) with severe burns over 30% of the total body surface area. Patients were randomized to placebo (22 control) or to Oxprop and began drug administration within 96 hours of admission. All patients began RET at hospital discharge as part of their standardized care. Muscle strength (N·m), power (W), VO2peak, body composition, and protein fractional synthetic (FSR) and breakdown (FBR) rates were measured pre- (PRE) and post-RET (POST). Muscle strength and power, lean body mass and VO2peak increased with RET in both groups (p<0.01). The increase in strength and power was significantly greater in Oxprop vs. control (p<0.01), and strength and power was greater in Oxprop over control POST RET (p<0.05). FSR was significantly higher in Oxprop than control post RET (p<0.01), resulting in improved protein net balance POST RET (p<0.05). RET improves body composition, muscle function and cardiorespiratory fitness in children recovering from severe burns. Oxprop therapy augments RET-mediated improvements in muscle strength, power, and protein turnover.