静脉营养及生长激素联合应用在外科危重病人的临床效果

A study of the combinant application of PN and GH in the therapy of critical care patients

目的研究静脉营养及生长激素联合应用在外科危重病人的临床效果。方法1998年1月～1999年12月，对16例外科危重病人应用静脉管养联合生长激素治疗。其中，多器官功能衰竭4例，胰腺癌术后3例，结肠癌术后4例，卵巢癌伴肠粘连1例，脑出血2例，急性坏死性胰腺炎1例，淋巴瘤术后1例。男：女＝11：3，平均年龄65．86±12．4岁，生长激素4．5～8U／d，生长激素应用时间：8．07±4．5d。结果（1）16例患者中痊愈出院9例，7例因严重感染，多器官功能衰竭，呼吸衰竭死亡。（2）在14例肾功能正常组（血肌研＜115μmol／L），治疗前血浆BUN9．439±2．068μmol／L，治疗后BUN7．056±1．882μmol／L，二者差异有非常显著性（P＜0．01）。（3）2例肾功能不正常的病例，治疗前BUN分别为19．19及28．02μmol／L，治疗后为28．81及33．74μmol／L。（4）血浆总蛋白及白蛋白水平治疗前后差异无显著性（治疗前31．8±5.1g／L，治疗后32．47±6．43g／L，P＞0．05）。结论在肾功能正常的情况下，术后危重患者应用生长激素可以降低血浆尿素氮水平，其临床意义及机理有待于进一步研究探讨。

objective To study the effect of combinant applications of PN and GH in the therapy of critical care patients. Methods We treated 16 cases of critical care patients with the combination of PN and GH,of which there were MOF in 4,acute pancreatitis in 1,the others are postoperative patients, including pancreatic cancer in 3, colon cancer in 4, ovaries cancer in 2, lyTnphoma in 1. Ma1e: Female = 11: 3, the average age is 65. 85 ±12. 4, the usage of the GH is 4. 5 ~ 8u/day. Results (1)9 cases were cured and the other 7 cases died from severe infection, MOF and respiratory failure. (2)in the cases whose renal function is normal, the BUN level significantly declined after the therapy. (BUN = 9. 4393 ±2. 068mmol/l before the therapy versus BUN = 7. 0564 ±1. 882mmol/l after the therapy, P< 0. 01 ) (3) in the 2 cases whose renal function were abnormal(Cr > 115umol/l), the BUN level before the therapy were 19. 19 mmol/l and 28. 02mmol/l, and 28. 81mmol/l and 33. 74mmol/L after the therapy. (4) The TP and ALB level after the therapy were not significantly diferent from before. (31. 8 ±5. 08g/l before the therapy versus 32. 47 ±6. 43g/l aftet the therapy. P >0.05). Conclusions In case of normal renal function, the combinant application of PN and GH in the therapy of critical care patients could reduce the BUN level in plasma. The clinical significance and its mechanism are to be further studied.