重组人生长激素治疗老年重度烧伤患者的临床观察

Clinical Observation of Recombinant Human Growth Hormone in the Treatment of Elderly Patients with Severe Burn

目的:探讨重组人生长激素(HGH)对老年重度烧伤患者血清内毒素、炎症因子、创面愈合时间、住院时间及预后的影响。方法:选取在我院治疗的老年重度烧伤患者96例,按随机数字表法分为治疗组和对照组,各48例。两组患者均给予创伤面护理、营养支持,维持水、电解质及酸碱平衡;对照组患者皮下注射0.9%氯化钠注射液1 ml,qd;治疗组患者给予注射用HGH 0.3 IU/kg皮下注射,qd。两组患者均治疗21 d。比较两组患者治疗前及治疗14、21 d后的血清内毒素含量,观察两组患者治疗前后血清炎症因子[肿瘤坏死因子(TNF)α、白细胞介素(IL)6、IL-8]水平和创面愈合时间、住院时间,计算两组患者多器官障碍综合征(MODS)、死亡、全身感染的发生率。结果:两组患者治疗前及治疗14 d后的内毒素含量比较,差异无统计学意义(P>0.05);治疗21 d后,两组患者血清内毒素含量明显降低,且治疗组患者明显低于对照组,差异有统计学意义(P<0.05)。治疗后,治疗组患者IL-8水平明显高于对照组,TNF-α、IL-6明显低于对照组,差异均有统计学意义(P<0.05)。治疗组患者各创面愈合时间及住院时间均显著短于对照组,差异均有统计学意义(P<0.05);治疗组患者MODS、死亡及全身感染的发生率均显著低于对照组,差异均有统计学意义(P<0.05)。结论:HGH能使老年重度烧伤患者吸收的毒素减少,改善炎症因子水平,从而促进患者创面愈合及改善预后。

OBJECTIVE：To discuss the effect of recombinant human growth hormone（HGH）on serum sndotoxin,inflammatory cytokines,wound healing time,hospitalization time and prognosis of elderly patients with severe burn. METHODS：96 elderly patients with severe burn in our hospital were randomly divided into treatment group（48 cases）and control group（48 cases）.All patients received wound surface care,nutritional support,maintaining water and electrolyte and acid-base balance. Control group received 1 ml 0.9% Sodium chloride solution,sc,qd. Treatment group received 0.3 IU/kg. Recombinant HGH for injection,sc,qd. All patients were treated for 21 d. Serum endotoxin content in 2 groups before and 14,21 d after treatment was compared,inflammatory cytokines（TNF-α,IL-6, IL-8） before and after treatment,wound healing time,hospitalization time and the incidence of multiple organ disorder syndrome（MODS）,death and systemic infection were observed. RESULTS：There was no significant difference in serum endotoxin content before and 14 d after treatment（P〈0.05）;after 21 d,serum endotoxin contents in 2group obviously decreased,and treatment group was significantly lower than control group,with statistical significance（P〈0.05）.After treatment,IL-8 level in treatment group was significantly higher than control group,TNF-α and IL-6 were significantly lower than control group,with statistical significances（P〈0.05）. Wound healing time and hospitalization time in treatment group were significantly shorten than control group,with statistical significances（P〈0.05）. The incidence of MODS,death and systemic infection in treatment group were significantly lower than control group,with statistical significances（P〈0.05）. CONCLUSIONS：The application of recombinant HGH in elderly patients with severe burn can reduce toxins absorption of patients and decrease inflammatory cytokines to promote wound healing and improve prognosis.