添加重组人生长激素的营养支持对严重多发伤患者营养状况的影响

Altered nutrition state in the severe multiple trauma patients with adjuvant recombinant human growth hormone nutritional support therapy

目的观察添加重组人生长激素(recombinant human growth hormone,rhGH)的营养支持对严重多发伤患者营养状况的影响。方法45例严重多发伤(ISS>25)患者随机分为三组,每组15例。三组均行标准营养支持,其中两组在术后48h行添加rhGH[分别为0.2和0.4IU/(kg.d)]的营养支持14d,第三组为对照组。不同时间点测定患者氮平衡试验、血浆前白蛋白水平和安全性指标(血糖、血Na+与血总T3、T4)。结果严重多发伤患者各实验组术后第3、5天氮平衡分别为(-1.28±3.190)、(5.45±2.00)和(-0.18±2.55)、(6.11±1.60),均较对照组(-5.17±1.68)、(-1.08±3.31)明显增高(P<0.01);各实验组术后第9天、第16天的血浆前白蛋白水平分别为(180.19±27.15)、(194.44±50.82)和(194.94±29.65)、(194.11±16.17),均较对照组(117.42±19.10)、(135.63±28.31)明显增高(P<0.01)。而实验组组间比较氮平衡和前白蛋白水平在各时间点的差异无统计学意义。术后第9天、第16天安全性指标水平三组之间差异均无统计学意义。结论严重多发伤患者在术后48h添加rhGH的营养支持可显著改善其营养状况,rh-GH在0.2和0.4IU/(kg.d)剂量下应用是安全的。

Objective To observe the nutrition state in the severe multiple trauma patients with adjuvant recombinant human growth hormone （rhGH） nutritional support therapy. Methods Forty - five patients with severe multiple traumas （ISS 〉 25） were randomly divided into 3 groups. There were 15 patients in each group. All the 3 groups had been supplied with nitrogen and caloricity according to the need of patients for 16 days. The rhGH therapy started 48 h after surgery and lasted for 14 days in two groups in which rhGH was 0.2 IU/（ kg · day） and 0.4 IU/（ kg · day ） respectively. The third group was control group. AU variables were measured at certain time points. The levels of nitrogen balance, prealbumin and safety variables （ blood sugar, Na ＋, TI3 and TY4） were compared among the three groups. Resuits The values of nitrogen balance on postoperative day （POD） 3 and 5 in the former two groups were - 1.28 ± 3.19,5.45 ± 2.00 and - 0.18 ± 2.55,6.11 ± 1.60, respectively, which were significantly higher than those in the control group （ - 5.17 ± 1.68, - 1.08 ± 3.31, P 〈 0.01 ）. The values of prealbumin on POD 3 and 5 in the former two groups were 180.19 ± 27.15,194.44 ± 50.82 and 194.94± 29.65, 194.11±16.17,respectively,which were significantly higher than those in the control group （ 117.42 ± 19.10,135.63 ± 28.31, P 〈 0.01 ）. However, there was no significant difference between the rhGH 0. 2 IU/（ kg · day） group and 0.4 IU/（ kg · day） group in both of the levels of nitrogen balance and prealbumin. There was no significant difference among the 3 groups in the levels of safety variables on the POD 9 and 16. Conclusion The nutritional support therapy with adjuvant rhGH which starts 48 h after surgery improves the nutrition state of the patients with severe multiple traumas. It is safe for severe multiple trauma patients who accept rhGH at the dose of 0.2 - 0.4 IU/（ kg · day）.