【摘要】 目的 :探讨生长激素合并低热量肠外营养 (PN)对术后多器官衰竭 (MOF)患者的影响。方法 :6 0例术后 MOF患者分为对照组 (30例 )和生长激素组 (30例 ) ,术后 4 8小时～ 16日为观察期 ,2组患者术后治疗和营养支持方案相同 ,营养支持总热量不超过 83.7～ 10 4 .6 k J· kg- 1 · d- 1 ,脂肪供热 4 0 % ,供氮量不超过 0 .12～0 .15 g· kg- 1 · d- 1 。生长激素组术后 4 8小时开始加用重组人类生长激素 (rh GH ,8U /d)皮下注射 ,连续 14日。监测所有患者治疗前后营养指标、免疫功能指标和营养耐受性指标 ,同时记录胰岛素应用情况、并发症及临床结果。结果 :所有患者术后血清转铁蛋白、前白蛋白、白蛋白水平、CD3、CD4 、NK活性及 CD4 /CD8比值均低于正常。使用 rh GH后第 7日生长激素组患者血清前白蛋白浓度明显高于治疗前和对照组 (P均 <0 .0 5 ) ,第 14日血清转铁蛋白、前白蛋白均显著高于对照组 (P均 <0 .0 1) ,而对照组患者治疗前后差异不明显 (P均 >0 .0 5 ) ;第 7日生长激素组恢复正氮平衡 ,生长激素组患者使用 rh GH后第 7日 CD4 、NK活性及 CD4 /CD8比值均明显高于治疗前 (P<0 .0 5或 P<0 .0 1) ,而对照组仍处于负氮平衡 (P<0 .0 5 )。治疗前后 CD4 、NK活性及 CD4 /CD8差异不明显 (P均 >0 .0 5 ) ,更多还原

【Abstract】 Objective:To investigate the effects of recombinant human growth hormone (rhGH) and hypocaloric parenteral nutrition (HPN) on postoperative multiple organ failure(MOF) patients.Methods:Sixty postoperative MOF patients were randomized into 2 groups,namely HPN+rhGH and control groups,with 30 cases each,and patients in both groups received standard treatment.Total calories and nitrogen were supplied in an amount of 83 7~104 6 kJ·kg -1 ·d -1 and 0 12~0 15 g·kg -1 ·d -1 respectively.Lipid calorie was supplied in a rate of no more than 40% of the total caloric value.In addition,8 U/d rhGH was subcutaneously injected daily in HPN +rhGH group 48 hours after operation for 14 days.The patients’ serum proalbumin,albumin,transferrin,the activity of T and NK cells and nitrogen balance were determined respectively on 0,4,7 and 14 days of treatment.Clinical outcome,blood sugar and insulin levels were also recorded.Results:Serum proteins were decreased in all patients after operation.During the course of the treatment,the prolbumin,albumin,transferrin,the activity of T and NK cells increased,and negative nitrogen balance was improved significantly in HPN +rhGH group compared with control.The incidence of complications were markedly lower in HPN+rhGH group than in control.Abnormal glucose,disturbance in fat metabolism or liver function did not occur in both groups.There was no death in both groups.Conclusions:The results suggest that rhGH and hypocaloric nutritional support could significantly improve the clinical outcome,decrease the incidence of complications in postoperative MOF patients.更多还原