低热量肠内营养联合生长激素在胃肠道肿瘤患者术后的应用

Application of Hypocaloric Enteral Nutrition Combined with Recombinant Human Growth Hormone in Postoperative Patients with Gastrointestinal Tumors

目的探讨低热量肠内营养联合重组人生长激素(rhGH)对胃肠道肿瘤患者术后蛋白质代谢的影响及其治疗效果。方法将2003年1月～2005年7月在我科行胃肠道肿瘤根治术的40例患者随机分成两组:低热量肠内营养支持+安慰剂为对照组(n=20);低热量肠内营养支持+rhGH为研究组(n=20)。rhGh在术后第3天开始应用,连续应用7天。观察患者术后蛋白质代谢和血清胰岛素样生长因子-1(IGF-1)的变化情况。结果研究组术后第5天恢复正氮平衡。两组血清白蛋白、前白蛋白、转铁蛋白、纤维连接蛋白、IGF-1在术后第3天均显著下降,治疗后有不同程度的恢复。研究组术后第10天前白蛋白、转铁蛋白、纤维连接蛋白和IGF-1显著高于对照组(P<0.05)。结论低热量肠内营养支持联合rhGH能促进胃肠道肿瘤患者术后的蛋白质合成,改善患者营养状况。

Objective To investigate the changes in protein metabolism and observe the therapeutic effects of hypocaloric enteral nutrition combined with recombinant human growth hormone （rhGH） in postoperative patients with gastrointestinal tumors. Methods From January 2003 to July 2005, forty patients with gastrointestinal tumors undergoing radical surgery were randomly divided into two groups ： the control group （ n = 20） , which was treated with hypocaloric enteral nutrition and placebo ; and the study group （ n = 20）, which was treated with hypocaloric enteral nutrition and rhGH. The rhGH was applied for 7 days started from the third postoperative day. The effects on all patients were evaluated in terms of protein metabolism and insulin like growth factor-1 （ IGF-1 ）. Results It caused a positive nitrogen balance from the fifth postoperative day in the study group. The levels of albu- min, prealbumin, transferrin, fibronectin, and IGF-1 on the third postoperative day remarkably decreased in two groups compared with preoperative levels. All these indicators were recovered to a great extent, but the administration of rhGH significantly increased the serum levels of prealbumin, transferrin, fibronectin, and IGF- 1 （P 〈 0.05 ）. Conclusion The application of hypocaloric enteral nutrition combined with rhGH increases protein synthesis and improves nutritional status in postoperative patients with gastrointestinal tumors.