Propranolol does not increase inflammation, sepsis, or infectious episodes in severely burned children
Propranolol does not increase inflammation, sepsis, or infectious episodes in severely burned children
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DOI：
10.1097/ta.0b013e318031afd3
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发表时间：
2007-03-01
影响因子：
--
通讯作者：
Herndon, David N.
中科院分区：
文献类型：
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作者：
Jeschke, Marc G.;Norbury, William B.;Herndon, David N.
背景：普萘洛尔是一种非选择性 β1-2 拮抗剂，可减轻严重烧伤患者的代谢亢进和分解代谢。然而，最近的数据表明普萘洛尔会损害免疫功能并加剧炎症。本研究的目的是确定普萘洛尔给药对严重烧伤儿科患者感染、败血症和炎症的影响。患者：进行了一项前瞻性、意向性治疗研究；患者人口统计数据（年龄、性别、烧伤面积和死亡率）；感染事件（菌落计数大于 10(5)）；确定了脓毒症（重症监护医学协会的指南）。高代谢反应通过静息能量消耗 (REE) 来确定，炎症反应通过测量血清细胞因子表达来确定。结果：本研究纳入了 245 名患者（143 名对照者，102 名普萘洛尔）。对照组和普萘洛尔组之间的年龄、性别分布、烧伤面积、三度烧伤和住院时间没有差异。对照组死亡率为 6%，普萘洛尔组死亡率为 5%。普萘洛尔显着降低 REE 并预测急性住院期间的 REE。对照组有 43 名患者出现感染（30%），普萘洛尔组有 21 名患者出现感染（21%）。对照组败血症的发生率为 10%，普萘洛尔为 7%。对每组 20 名患者的细胞因子表达谱分析显示，与对照组相比，普萘洛尔显着降低了血清肿瘤坏死因子和白细胞介素 1β（p < 0.05）。结论：普萘洛尔治疗减轻了代谢亢进，并且不会导致感染和败血症发生率增加。
Background: Propranolol, a nonselective beta 1-2 antagonist, attenuates hypermetabolism and catabolism in severely burned patients. However, recent data suggest that propranolol impairs immune function and enhances inflammation. The purpose of the present study was to determine the effect of propranolol administration on infection, sepsis, and inflammation in severely burned pediatric patients.Patients: A prospective, intent-to-treat study was performed; patient demographics (age, gender, burn size, and mortality); infectious episodes (colony count greater then 10(5)); and sepsis (guidelines by the society of critical care medicine) were determined. Hypermetabolic response was determined by resting energy expenditure (REE), and the inflammatory response was determined by measuring serum cytokine expression.Results: Two hundred forty-five patients (143 controls, 102 propranolol) were included into the study. There were no differences between the control and propranolol groups for age, gender distribution, burn size, third degree burn, and length of stay. Mortality was 6% in the control group and 5% in the propranolol group. Propranolol significantly decreased REE and predicted REE during acute hospital stay. Forty-three patients developed infections in the control group (30%), whereas 21 developed infections in the propranolol group (21%). The incidence of sepsis was 10% for controls and 7% for propranolol. Analysis of the cytokine expression profile in 20 patients in each group revealed that propranolol significantly decreased serum tumor necrosis factor and interleukin-1 beta compared with controls (p < 0.05).Conclusion: Propranolol treatment attenuates hypermetabolism and does not cause increased incidence of infection and sepsis.