摘要
目的 从代谢角度评估大面积烧伤患者术后应用重组人生长激素 (rhGH)的临床价值。方法 选择 5 0例严重烧伤患者 ,随机等分为生长激素治疗组 (rhGH组 )和对照组 ,伤后 3d内手术切痂植皮 ,rhGH组术后每天皮下注射rhGH共 10d ,动态观察不同时间点的血生长激素、血糖、血胰岛素、抗胰岛素抗体、血胰高血糖素、皮质醇、血浆氨基酸谱、转铁蛋白、前白蛋白、总蛋白、电解质及静息能量消耗 (REE)和尿中 3 三甲基组氨酸 ( 3 MH)水平的变化。 结果 2组患者术前血生长激素浓度较正常值降低 ,差异有显著性意义 (t=2 80 6,P <0 0 5 ) ,应用rhGH后血生长激素浓度较对照组增高 ,差异有显著性意义 (t=2 0 14 ,P <0 0 5 ) ;血胰岛素水平 2组均高于正常值 ,rhGH组胰岛素水平增高 ,较对照组差异有显著性意义 (t=3 14 2 ,P <0 0 5 ) ;胰高血糖素水平、抗胰岛素抗体和皮质醇虽有不同程度的增高 ,但 2组差异无显著性意义 ;血浆氨基酸水平都低于正常值 ,rhGH组下降较对照组差异有显著意义 (t=2 714 ,P <0 0 5 ) ;同时尿 3 MH排出明显减少 (t=2 2 0 7,P <0 0 5 ) ;rhGH组血糖、前白蛋白、转铁蛋白自应用rhGH后显著高于对照组 (t=2 62 4～ 3 0 4 4 ,P <0 0 5 ) ;应用rhGH后REE峰值前移 ,但自应用rhGH第 10天?
Objectives To observe the effect of recombinant human growth hormone on metabolism in severely burned patients. Methods From January 1999 to January 2001, 50 patients, aged 12 to 50 years, with over 30% total body surface area (TBSA) and 10% full thickness burns, were randomized in a double blind study In the control group, normal saline was used as a placebo, while 0 3 IU·kg -1 ·d -1 recombinant human growth hormone was given from postoperative day (POD) 1 to day 10 in the rhGH group The excised burn wounds were closed with microautograft and allograft skin Blood samples were collected at 6:00 am for assaying of growth hormone, blood glucose, blood insulin, anti insulin antibody, glucagon, cortisol, serum amino acid profile, transferrin, proalbumen, total protein, electrolytes, and resting energy expenditure (REE). Results The concentration of blood GH in both groups was lower ( t= 2 806, P< 0 05) than that of physiological values before surgery However, the concentration of GH on POD 3 in the rhGH group was significantly higher than that of normal values, but a higher level was observed on POD 7 in the rhGH group than that of the control group( t= 3 142, P< 0 05) Although the concentration of anti insulin antibody was slightly increased, there was no significant difference between the two groups The concentration of glucagons trended to decrease with an increase in the concentration of blood glucose, and it was marked in the rhGH group There was no significant difference between the two groups. The concentratin of cortisol was higher than normal values, but no significant difference was observed between the two groups. With the administration of rhGH, the plasma concentration of amino acids was lower than that of the control group( t= 2 714, P< 0 05), and the urinary output of 3 MH in the rhGH group was lower than that of the control group( t= 2 207, P< 0 05). The plasma concentration of blood glucose, proalbumen and TRF was higher than that of cont
出处
《中华外科杂志》
CAS
CSCD
北大核心
2002年第2期107-111,共5页
Chinese Journal of Surgery
基金
解放军军队医药卫生科研基金资助项目 ( 98M15 5 )
