生长激素联合谷氨酰胺低热量肠外营养对外科重症病人的影响

Clinical study of hypocalorie PN with growth hormone and glutamine on the course of disease in severe ill patients

目的观察生长激素(rhGH)联合谷氨酰胺(Gln)低热量肠外营养(PN)对外科重症病人的优化营养支持作用.方法 2004年4～9月,上海交通大学附属第六人民医院对30例外科重症病人施行常规PN、低热量PN+rhGH、低热量PN+rhGH+Gln治疗.在第1、5、8天分别观察血浆前白蛋白、转铁蛋白、氮平衡、血内毒素、APACHE Ⅱ评分;第8天测3-甲基组氨酸、尿乳果糖/甘露醇比值;治疗结束后分析预后的变化.结果低热量PN+rhGH+Gln组病人第8天时,氮平衡、尿3-MH、尿乳果糖/甘露醇比值、血内毒素水平、APACHE Ⅱ评分以及治疗期间ICU住院时间低于常规PN组和低热量PN+rhGH组.结论 rhGH联合Gln低热量PN能减轻机体代谢负担,促进蛋白合成和肠道屏障功能恢复,改善预后.

Objective To observe the effect of hypocalorie PN with growth hormone and glutamine on the course of disease in severe ill patients. Methods Between April 2004 and September 2004, 30 severe ill patients were performed the treatment of conventional PN, hypocalorie PN ＋ rhGH, hypocalorie PN ＋ rhGH ＋ Gin to evaluate the difference between plasma pre-albumin, transferrin, nitrogen balance, endotoxin, APACHE Ⅱ at the 1st, 5th and 8th day, 3-MH, lactulose mannitol ratio at the 8th day and the prognosis at the end of treatment. Results At the 8th day,the level of nitrogen balance, 3-MH, lactulose mannitol ratio, endotoxin, APACHE Ⅱ, the length of stay in the ICU in hypocalorie PN ＋ rhGH ＋ Gln group was better than conventional PN group and hypocalorie PN ＋ rhGH group. Conclusions Hypocalorie PN ＋ rhGH ＋ Gin is beneficial to the severe ill patients by increasing protein synthesis, It also has a positive effect on the recovery of intestinal permeability and the improvement of the prognosis.