生长激素在门脉高压症大出血断流术后的应用体会

Application of growth hormone after disconnection of portalsystemic shunt for the portal hypertension patients with bleeding

目的 :探讨生长激素 (GH)对肝功能ChildC级门脉高压症合并上消化道大出血内科治疗无效而被迫行断流术后出现的顽固性低蛋白血症和难控性腹水的治疗价值。 方法 :2 0例病人随机分为三组 :A组为 ,肠外营养(PN) 8天 ;B组为PN +GH ,PN同A组 ,应用重组人GH(rhGH) 8U ,1次 /d ,7天 ;C组为单纯rhGH组 ,rhGH应用方法同B组。术后动态观察血浆蛋白、腹水、病死率和其他一般情况。 结果 :PN +rhGH术后 1周起白浆蛋白水平高于其他两组 ,腹水消退快 ,一般情况好 ,无死亡病例。 结论 :肝功能ChildC级门脉高压合并上消化道大出血内科治疗无效 ,急诊断流术后应用PN加生长激素对纠正顽固性低蛋白血症、控制术后腹水的增长有良好的疗效 ,作用较持久 ,可减少术后病死率 ,改善病人生活质量 ,但一定要给予静脉营养支持以提供必要的蛋白合成底物和能量。同时临床经验告诉我们 ,rhGH的应用一定要足量、足疗程。

Objectives:To study the effects of recombinant human growth hormone(rhGH) in treatment of portal hypertension patients with hypoproteinemia and intractable ascites. Methods:20 cases of patients with portal hypertention (Child's Class C) with bleeding were randomly divided into 3 groups and rhGH was used to treat hypoproteinemia and intractable ascites only or with parenteral nutrition in the postoperative period. Results:The hypoproteinia and ascites were alleviated,the incidence rate of postoperative complications and mortality were reduced,and the life quality of the patients was improved in patients in whom rhGH had been used,especially when used simultaneously with parenteral nutrition. Conclusions:The postoperative use of rhGH is beneficial to alleviate the hypoproteinemia and ascites in patients with portal hypertention,especially when combined with the use of parenteral nutrition.