添加重组人生长激素的营养支持对烧伤脓毒症危重病人营养状况的影响  

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

作　　者：吴祖煌[1,2] 宋斌[1,2] 黄永新[1,2] 陈建崇[1,2] 陈国养[1,2] 

机构地区：[1]南京军区福州总医院第一附属医院 [2]福建医科大学福总临床医学院烧伤整形科,福建莆田351100

出　　处：《肠外与肠内营养》2011年第4期207-210,214,共5页Parenteral & Enteral Nutrition

摘　　要：目的:观察添加重组人生长激素(rhGH)的营养支持对烧伤脓毒症危重病人营养状况的影响,探讨rhGH在烧伤脓毒症治疗中的作用。方法:42例烧伤脓毒症危重病人[烧伤面积(TBSA)≥30%]随机分为治疗Ⅰ组、治疗Ⅱ组和对照组,每组各14例。三组病人除实施相同的脓毒症综合治疗方案和标准营养支持外,其中两组皮下注射rhGH为0.2和0.4 U/(kg.d);对照组皮下注射等量的等渗盐水,每天1次,连续10 d。在给药前后不同时相点取血测定并对比分析三组间血浆前清蛋白(PA)、肿瘤坏死因子α(TNF-α)、降钙素前体(PCT)和微量空腹血糖(FBG)水平、糖化血红蛋白(HbAIC)和氮平衡(NB)试验的变化。比较三组间平均住院日和创面愈合时间。结果:①三组病人伤后NB和PA水平均明显下降,对照组下降更为明显。②治疗Ⅰ组和治疗Ⅱ组在平均住院日、供皮区和植皮区及烧伤创面愈合时间较对照组缩短。③三组病人FBG均明显升高,治疗Ⅱ组升高更明显。两组HbAIC无显著性差异。④三组病人PCT、TNF-α均明显升高,对照组升高最显著。结论:烧伤脓毒症危重病人添加rhGH的营养支持,可显著改善病人的营养状况。应用0.2和0.4 U/(kg.d)的rhGH是安全的,对改善营养无明显差异。Objective：To observe the nutrition state in the severely burn sepsis patients with adjuvant recombinant human growth hormone（rhGH） nutritional support therapy. Methods：42 cases were randomized into three groups.All the three groups had been supplied with nutrition according to the need of patients.Besides parenteral nutrition,rhGH was given subcutaneously in the dosage of 0.2 U/（kg·d） and 0.4 U/（kg·d） in two treatment groups respectively.The plasma concentration levels of pre-albumin（PA）,procalcitonin（PCT）,tunmor necrosis factor-α（TNF-α）,fasting blood glucose（FBG）,glycated hemoglob（HbAIC）,nitrogen balance（NB） were measured after burn injury.Results：①The serum PA and NB were decreased three groups（P0.01～0.05）.②Length of hospital stay and the healing time of donor site and burn wound were significantly shortened in two groups of rhGH compared with control group（P0.05）.③There was no significant difference of HbAIC between treatment groupⅠ and treatment groupⅡ.④The serum levels of TNF-α,FBG,PCT in treatment groupⅠ and treatment groupⅡ were markedly lower than those of control group（P0.01～0.05）.Conclusion：The nutrition support therapy with adjuvant rhGH is beneficial to the nutrition state of the patients with burn sepsis.It is safe for severe burn sepsis patients who treated with rhGH at the dose of 0.2～0.4 U/（kg·d）.

关 键 词：重组人生长激素 营养支持 氮平衡 前清蛋白 

分 类 号：R644[医药卫生—外科学] R459.3[医药卫生—临床医学]