重组人生长激素对心脏手术后疲劳综合征的影响

目的 观察重组人生长激素（rhGH)对心脏手术后疲劳综合征（POFS）的治疗效果。方法 按随机、对照、双盲的原则收集心脏手术后病人60例，分为A组（rhGH治疗组）和B组（对照组），每组30例。对两组病人作疲劳记分（Christensen记分），并测定血清生长激素（GH）的水平和血浆蛋白等指标；计算术后氮平衡。结果 A组术后疲劳程度明显轻于B组（P＜0.01），脱离呼吸机时间早于B组（P＜0.01）；血清GH水平升高程度强于B组（P＜0.01）；术后第1天，视黄醇结合蛋白（RBP）水平显著高于B组（P＜0.05）；术后第4、8天血浆转铁蛋白（TFN）、前白蛋白（PA）和RBP水平均显著高于B组（P＜0.01）；术后第1－7天氮平衡的改善明显好于B组（P＜0.01）。结论 （1）使用外源性rhGH，能减轻POFS的程度，有助于病人及早脱离呼吸机，能在较短时间内改善病人营养状况，较快达到正氮平衡。（2）血浆急性期蛋白（RBP、PA和TFN等）的水平是判断POFS的一种可靠的生化判断旨标，它们的减少与POFS的发生有关。

Effect of recombinant human growth hormone on postoperative fatigue syndrome in patients after cardiac operations

OBJECTIVE: To observe the effect of recombinant human growth hormone (rhGH) treatment on postoperative fatigue syndrome (POFS) in patients after cardiac surgery under cardiaopulmonary bypass (CPB). METHODS: 60 patients undergoing open heart surgery were randomly divided (double blind trial) into two groups : group A (injected with rhGH, 4.5 U Bid for 5-7 days) and group B (administrated with placebo). The patients were asked to score their sense of fatigue (Christensen scores). Their 24-hour urine was collected to calculate the daily nitrogen balance. The serum growth hormone (GH) and plasma proteins were detected. RESULTS: In the 4(th) day after operation, the level of fatigue was increased significantly in both groups, however, being lower in group A then in group B, and returned to the pre- operative level in the 8(th) postoperative day in group A (P < 0.01 ). The serum GH was similar in both groups before operation and was significantly increased on the first, fourth, and eighth days, especially the first day, postoperatively in group A (P < 0.01). The plasma total protein and albumin were similar in both groups before operation and on the first and fourth days postoperatively. On the 8(th) day postoperatively the plasma TP and albumin were significantly higher in group A than in group B (P < 0.05 and P < 0.01 respectively). The plasma retinol binding protein (RBP), prealbumin (PA), and transferrin (TFN) were similar in both groups before operation, on the first day after operation the plasma PA and TFN were lower than before operation in both groups. On the first postoperative day, the plasma RBP was higher in group A than in group B (P < 0.05), on the fourth day after operation the plasma PA and TEN were significantly higher in group A than in group B (P < 0.01). The time needed to wean from mechanical ventilation was 15.44 +/- 5.66 hr and 22.66 +/- 10.66 hr in groups A and B respectively (P < 0.01). In group A four patients established positive nitrogen balance on the second postoperative day and all patients in group B failed to obtain positiver nitrogen balance till the seventh postoperative day (P < 0.01). CONCLUSION: 1) Application of exogenous rhGH improves the symptoms of POFS, reduce the duration of POFS, and shorten the time needed to wean from mechanical ventilation, elevate plasma albumin, PA, TFN and RBP levels, and improve negative nitrogen balance. 2) The acute phase plasma proteins (such as PA, TFN, and RBP) are reliable biochemical indicators of POFS.