低热量肠外营养联合生长激素在老年重症胆管炎病人中的疗效分析

Therapeutic effect of low calorie of parenteral nutrition combined with growth hormone for elderly patients with severe cholangitis

目的:探讨老年重症胆管炎(acute cholangitis of severe type,ACST)病人给予低热量肠外营养(PN)支持和生长激素(rhGH)治疗的效果。方法:以低热量、低糖、低脂肪为总原则,对50例老年重症胆管炎病人实施PN,总热量不超过63～84 kJ/(kg·d),供氮量不超过0.10～0.12g/(kg·d)。脂肪供热不超过40%,配合短程小剂量rhGH治疗。观察治疗前后血清白蛋白、前白蛋白、转铁蛋白、肌酐指数、总淋巴细胞计数和氯平衡等的变化。结果:治愈46例,死亡4例。治疗过程中未出现明显的糖、脂代谢异常和肝酶谱变化的代谢性并发症。采用低热量PN和生长激素治疗后血浆蛋白水平显著升高,氮平衡、肌酐指数得到明显改善。结论:低热量PN与rhGH联合应用是治疗老年急性重症胆管炎有效的支持方法。

Objective： To evaluate the curative effects of hypocaloric parenteral nutrition （HPN） and recombinant human growth hormone （rhGH） on the senile acute cholangitis of severe type （ACST） patients. Methods： HPN and lower rhGH （Saizen） were given to 50 senile ACST patients in the principle of low calorie, low carbohydrates and low fat. Total energy and nitrogen were supplied 62.8-83.7 kJ/（ kg·d ） and 0.10-0.12g/（ kg·d ）, respectively. The rate of non-protein nitrogen/nitrogen was 100：1-120：1. Lipid energy was supplied in a rate of no more than 40 percent of the energy. Serum albumin, transferrin （TFN）, creatine height index （CHI）, total lymphocyte count （TLC） and nitrogen balance were determined. Results： 46 cases were cured and 4 died. No complications of abnormal glucose and fat metabolism and liver function occurred in the course of the treatment. The contents of albumin, pre-albumin, transferrin, CHI, TLC increased and nitrogen balance significantly improved after the application of HPN and GH. Conclusion： The associated application of HPN and GH is effective for the senile ACST patients.