生长激素加早期肠内营养对高血压脑出血病人术后营养状况及并发症的影响

目的:探讨生长激素(GH)加早期肠内营养对高血压脑出血(HICH)病人术后营养状况及并发症的影响.方法:将122例高血压脑出血术后病人随机分成治疗组和对照组,每组61例.治疗组术后第2天开始肠内营养(EN)支持,同时每天联合应用GH,连用1周.对照组术后第2天开始胃肠外营养(TPN)支持.测定手术当天、术后第2天(营养支持第1天)和第3、7、14、21天的多项营养指标,并观察两组的临床疗效和并发症.结果:治疗组血清前清蛋白、转铁蛋白、清蛋白和氮平衡均明显高于对照组(P＜0.05);治疗组肺部感染、应激性溃疡和电解质紊乱发生率明显低于对照组(P＜0.05～0.01);治疗组平均入住ICU时间明显短于对照组(P＜0.05);治疗组第21天GCS评分＞8分的病人百分率明显高于对照组(P＜0.01).结论:生长激素联合早期肠内营养不仅可迅速改善高血压脑出血术后病人的营养状况、减少并发症,而且可缩短入住ICU时间,提高临床疗效.     

重组人生长激素与不同负荷营养支持对腹部大手术后病人代谢的影响

目的:观察不同营养负荷下重组人生长激素(rhGH)对腹部大手术后病人机体代谢所产生的影响.方法:将32例病人随机分为三组:即A组(低热量组)11例,用83.68 kJ/(kg·d)营养支持;B组(低热量加rhGH组)10例,术后第1～7天用83.68 kJ/(kg·d)﹢rhGH 4 U/d营养支持;C组(高热量加rhGH组)11例,术后第1～7天用125.52 kJ/(kg·d)﹢rhGH 4 U/d营养支持.术后观察病人尿氮排出量的变化、血清清蛋白和前清蛋白水平.结果:术后第8天B组和C组血清前清蛋白明显高于A组(P＜0.05),其中C组明显高于B组(P＜0.05).术后第1～8天各组尿氮排出量均大于术前.术后第4天开始,B组和C组尿氮排出量减少,与A组比差异有显著性意义.术后第8天C组尿氮排出较B组下降更明显.结论:在腹部大手术后应用rhGH的条件下,适度地增加营养负荷,可以达到较好的效果.     

重组人生长激素在肝胆外科老年病人术后恢复中的应用

目的:评价重组人生长激素(rhGH)在肝胆外科老年病人术后恢复中应用的疗效. 方法:2004年1月至2005年12月在3所不同医院的肝胆外科中选择腹腔镜胆囊切除的65岁以上的病人共40例,随机分为生长激素组和等渗盐水组,每组各20例.分别应用rhGH 4 U,连续4 d和等渗盐水4 d.于手术前2 d,术后第1、3、7和14天作为观察点. 结果:两组病人在总住院天数、清蛋白水平、握力试验和疲劳评分等方面改善有明显差异,生长激素组明显优于等渗盐水组. 结论:在老年病人腹部手术后应用生长激素能缩短住院时间,提高营养水平,明显改善术后疲劳综合征的程度.     

免疫肠内营养在高龄胃癌病人术后免疫调节作用的观察

目的:观察免疫肠内营养对高龄胃癌病人术后恢复、免疫功能、营养状况的影响。方法:将68例高龄胃癌病人(70岁)手术后随机分为免疫肠内+肠外营养(EN+PN)组和肠外营养(PN)组。于术前1 d、术后第1和第7天检测相关的营养和免疫血清指标,观察术后恢复情况,并比较和分析。结果:两组病人术后第1天血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、Ig G、Ig A水平以及CD3、CD4、CD4/CD8较术前1 d有显著下降。术后7天EN+PN组血清TP、ALB、PA、Ig G、Ig A以及CD3、CD4、CD4/CD8与PN组比有显著性差异(P0.01)。术后EN+PN组和PN组发生术后并发症无显著性差异。结论:早期使用肠内免疫营养制剂,可改善高龄胃癌病人手术后的免疫功能和营养状态。     

肠内营养在食管破裂病人治疗中的应用

目的:尝试解决食管破裂术后病人的营养不良问题,使病人得以顺利康复. 方法:本组病人通过术中留置鼻肠管给予肠内营养﹢谷氨酰胺﹢生长激素,术后肠内营养直至病人可以正常进食.测得术前、术后第1、5、8和12天外周血转铁蛋白、前清蛋白、清蛋白含量,结果采用组内比较. 结果:27例病人全部康复出院,无一例死亡.转铁蛋白、前清蛋白和清蛋白均于术后第1天明显下降(P＜0.05 ),术后第5天恢复至术前水平.转铁蛋白和前清蛋白于术后第8天开始明显优于术前水平(P＜0.05). 结论:食管破裂病人给予肠内营养支持治疗能降低手术风险,术后恢复顺利.     

生长激素对门静脉高压症病人肝蛋白质合成的影响

目的:了解生长激素(GH)对经颈静脉肝内门体分流术(TIPS)后门脉性肝硬化病人肝蛋白质代谢的影响. 方法:对10例门静脉高压症病人,在TIPS术后第2天开始皮下注射重组人生长激素(rhGH)8 U×7天.检测治疗前及治疗后3、7天血清清蛋白(Alb)、前清蛋白(PA)、纤维连接蛋白(FN)水平,同时测定血清胰岛素样生长因子(IGF-1)水平,进行治疗前后的比较. 结果:血清IGF-1水平TIPS术前与术后比较无显著差异,GH治疗后3天明显升高(P<0.01);Alb水平TIPS术前与GH治疗后3天比较无显著差异,7天后明显升高(P<0.05);PA和FN水平在GH治疗后第3天开始升高,第7天明显升高 (P<0.01). 结论:GH可以促进肝硬化门静脉高压症病人肝蛋白质合成.     

胃癌术后早期肠内免疫营养的作用

目的:研究肠内免疫营养对胃癌手术后病人营养、免疫及炎症反应的影响. 方法:将96例胃癌病人随机分为肠内免疫营养组(研究组)和常规肠内营养组(对照组),分别于术后第2～8天给予等氮、等热量的肠内营养支持.于手术前1天、术后第1天和第9天分别检测总蛋白、清蛋白、前清蛋白、转铁蛋白、IgG、IgM、IgA、CD4、CD8、CD4/CD8、IL-1α、IL-2、IL-6、IL-10、TNF-α等项目,用药期间留24 h尿、粪测定氮,计算氮平衡. 结果:研究结束时研究组前清蛋白、IgA、CD4、CD4/CD8均显著高于对照组,IL-6、TNF-α显著低于对照组. 结论:肠内免疫营养可减轻胃癌病人手术创伤后机体炎症反应,改善免疫功能.     

肝移植术后病人应用鱼油脂肪乳的临床研究

目的:探讨鱼油脂肪乳在肝移植术后的临床应用及其对预后的影响. 方法:将36例肝移植术后病人随机分为鱼油组和对照组,每组18例.术后第2天开始给予等氮等热量的营养支持,共6d,其中鱼油组ω-6/ω-3比值为2∶1,对照组为7∶1.病人分别于术前、术后第2、5、8天抽血检测肝肾功能、血清清蛋白(ALB)、前清蛋白(PA)、...     

腹部术后早期功能锻炼预防肠粘连的临床观察

目的:探讨术后早期功能锻炼促进胃肠蠕动,预防肠粘连的作用。方法:200例腹部束后病人随机分为实验组与对照组。实验组于术后6h开始功能锻炼,对照组于术后第2天开始常规方法锻炼。结果:两组病人术后肛门排气时间、肠蠕动恢复时间、拔胃管时间及肠粘连发生率均有统计学意义(P<0.05),肠瘘及切口裂开的发生率无显著性差异(P<0.05)。结论:腹部术后早期功能锻炼能有效促进胃肠蠕动的恢复,起到预防肠粘连的作用。     

用生长激素治疗肝硬化低蛋白质血症疗效观察

目的:探讨重组人生长激素对肝硬化低蛋白质血症病人的治疗效果.方法:将28例血清清蛋白含量＜35g/L的肝硬化低蛋白质血症的病人随机分为两组:治疗组给予重组人生长激素4 U,肌内注射,1次/2 d,30天为一疗程,同时给予保肝、对症治疗;对照组只给予相同方案的保肝、药物对症治疗.分别于治疗后30、60、90天测定有关指标,观察治疗后血浆蛋白、凝血酶原、纤维蛋白原等变化规律.结果:治疗后30天,两组血清总蛋白、清蛋白含量均上升,治疗组上升更明显;治疗组90天后与治疗前相比血清总蛋白、清蛋白继续保持在高水平状态(P＜0.01);显效(9例)64%,总有效率78%;5例维持疗效长达4年之久,肝功能,凝血酶原、纤维蛋白原等均明显好转.而对照组血清清蛋白逐渐降低,部分恢复至治疗前水平.结论:重组人生长激素可明显提高肝硬化低蛋白质血症病人血清清蛋白水平,改善肝功能,中远期疗效好.     

TPN联合重组人生长激素在腹部大手术的应用

目的 研究腹部大手术后联合使用重组人生长激素（ｒｈＧＨ）和ＴＰＮ对病人氮平衡及营养状况的影响,方法 选择２７例接受腹部大手术和完全胃肠外营养的病人,随机分为研究组（１５例）和对照组（１２例）术后连续７天,每天皮下注射重组人生长激素４单位或安慰剂（等渗盐水）,结果：ｒｈＧＨ＋ＴＰＮ显著促进了氮平衡的恢复,提高了血浆白蛋白和转转蛋白水平,增加了体重和肌酐／身高指数,并降低了血尿素氮,但对肱三头肌皮皱厚     

重组人生长激素在外伤性呼吸困难老年病人肠内营养中的应用

目的:研究重组人生长激素(rhGH)对胸部外伤限制性呼吸困难老年病人的应用.方法:选择多发性肋骨骨折(＞3根)病人16例,年龄均＞70岁,随机分为两组,每组8例.治疗组采用肠内营养 GH,其中GH每天12U,共计8天.对照组仅采用肠内营养.治疗前和治疗后第8天,分别测定血清清蛋白、转铁蛋白、前清蛋白浓度和双手握力试验,观察坠积性肺炎的发生情况.结果:治疗组病人第8天的血清清蛋白、转铁蛋白和前清蛋白水平比对照组明显升高(P＜0.01),双手握力试验较治疗前明显提高(P＜0.01);治疗组病人坠积性肺炎的发生率较对照组明显降低(P＜0.05).结论:rhGH 肠内营养支持可以明显改善老年病人蛋白质合成代谢,增加肌肉的收缩力,增强排痰力度,减少了坠积性肺炎的发生率.     

Nutritional, respiratory, and psychological effects of recombinant human growth hormone in patients undergoing abdominal aortic aneurysm repair.

BACKGROUND: Recombinant human growth hormone (rhGH) has been shown to have powerful anabolic effects and to reduce or even prevent nitrogen catabolism in stressed patients. The effects of rhGH on functional parameters are less clearly defined. The aim of this study was to assess the effects of perioperative rhGH on nutritional markers, skeletal muscle function, and psychological well-being in patients undergoing infrarenal, abdominal aortic aneurysm repair. METHODS: Thirty-three patients undergoing elective infrarenal abdominal aortic aneurysm repair were randomized to one of three groups: (1) control (n = 12): placebo for 6 days before and after surgery; (2) preop + postop (n = 10): rhGH (Genotropin; Pharmacia Ltd, Uppsala, Sweden) 0.3 IU/kg/d for 6 days before and after surgery; and (3) postop (n = 11): placebo for 6 days before and rhGH 0.3 IU/kg/d for 6 days after surgery. Patients were assessed on days -7 and -1 before surgery and days 7, 14, and 60 after surgery. RESULTS: Administration of rhGH resulted in increased insulin-like growth factor 1 levels, the increase being significantly more marked in the group given rhGH preoperatively. Preoperative and postoperative rhGH reduced the postoperative decrease in both serum transferrin and grip strength at day 7 by 30% and 70%, respectively. Postoperative respiratory function and arterial oxygenation also were improved, with significant differences in arterial oxygenation between rhGH-treated and untreated groups. No difference in mood was seen between groups after surgery, nor was there any difference between subjective assessment of fatigue scores between groups. CONCLUSIONS: This pilot study indicates that rhGH administered preoperatively has beneficial effects on skeletal muscle and respiratory function and may be more useful than postoperative rhGH administration alone.     

Combination of recombinant human growth hormone and glutamine-enriched total parenteral nutrition to surgical patients: effects on circulating amino acids

BACKGROUND & AIMS: Both recombinant human growth hormone (rhGH) and glutamine (GLN) may have beneficial anabolic actions on amino acid metabolism. The aim of this study was to evaluate the additive effects of rhGH and GLN on plasma amino acids postoperatively. METHODS: 31 females undergoing laparoscopic cholecystectomy were randomized to three groups: Group I (n=10) received 13 IU/m(2) of rhGH the morning of surgery and the following three postoperative days, together with glutamine-free TPN for the first two postoperative days. Group II (n=11) received rhGH as the first group, together with glutamine-enriched (7 g GLN/m(2)/day) TPN. Group III (n=10) received glutamine-enriched TPN as the second group, but rhGH was replaced by placebo. Daily plasma amino acid concentrations and nitrogen balance were determined. RESULTS: In the GH treated groups, the plasma concentrations of several amino acids were decreased on the third postoperative day, compared to preoperatively. This was not observed in Group III. The changes were more pronounced in Group II. In Group II the negative AV-differences of amino acids tended to be attenuated, while the patients in Group III had increased negative AV-differences. The cumulative nitrogen balance was significantly improved in the GH groups, compared with Group III. CONCLUSION: The combined treatment of growth hormone and glutamine has additive effects on AV-balances of amino acids postoperatively, whereas nitrogen balance is not further improved when adding glutamine to rhGH treatment.     

谷氨酰胺和重组人生长激素对门静脉高压症患者术后肠黏膜屏障功能的影响

目的研究单独或联合应用谷氨酰胺（Gln）和重组人生长激素（rhGH）对门静脉高压症患者术后肠黏膜屏障功能的影响。方法将29例肝硬化门静脉高压症接受手术治疗的患者随机分为4组：Gln组（n=6）、rhGH组（n=8）、Gln＋rhGH组（n=7）和对照组（n=8）。术后3天开始进行等氮、等热量的全胃肠外营养（TPN）支持，持续7天。对患者手术前、后的尿乳果糖／甘露醇（L／M）、十二指肠降段黏膜绒毛高度及陷窝深度进行测定。结果Gln＋rhGH组L／M升高的幅度显著小于对照组（P〈0．05），Gln和rhGH组与对照组比较差异无显著性。Gln＋rhGH组肠黏膜绒毛高度和陷窝深度均大于对照组（P〈0．05），Gln和rhGH组与对照组比较差异无显著性（P〉0．05）。Gln＋rhGH组术后绒毛高度及陷窝深度均显著大于术前（P〈0．05）；对照组术后绒毛高度小于术前（P〈0．05），陷窝深度差异无显著性（P〉0．05）；Gln和rhGH组手术前、后绒毛高度及陷窝深度差异无显著性（P〉0．05）。结论联合应用Gln和rhGH能降低门静脉高压症患者术后肠壁通透性并维护肠黏膜形态学完整性，单独应用Gln或rhGH无此作用。     

Effects of preoperative parenteral nutrition on cell-mediated immunity in malnourished patients

Cell-mediated immunity was studied in 19 malnourished patients admitted for major abdominal surgery. Nine of them received total parenteral nutrition (TPN) before operation (the TPN group), while ten (the control group) were operated on without a period of TPN. In vitro lymphocyte proliferative responses to phytohaemagglutinin (PHA), concanavalin A (Con A) and purified protein derivative of tuberculin (PPD), were measured in whole blood cultures preoperatively, at the end of surgery and 5 days after operation. In vivo delayed skin hypersensitivity to candida, mumps, streptokinase-streptodornase and PPD was studied preoperatively and 5 days after operation. Complications in both groups were observed and recorded. Nutritional assessment was carried out by evaluating the extent of recent weight loss, the weight for height index and by measuring the arm muscle circumference (AMC), triceps skinfold thickness (TSF), the creatinine-height index (CHI) and serum albumin and prealbumin concentrations. The patient was considered to be malnourished and was included in the study, if at least three of these criteria were abnormal. In the TPN group changes in mitogen induced lymphocyte proliferative responses caused by surgery were not significant. By contrast, responses in the control group decreased significantly (P < 0.01) during surgery and most of these responses differed from the preoperative values even at the fifth postoperative day. Anergy was equally common in both groups before and after surgery. The number of infectious complications was lower in the TPN group.     

重组人生长激素对慢性腹腔感染病人蛋白质代谢的影响

目的：研究重组人生长激素对促进慢性腹腔感染病人蛋白质代谢的影响。方法：20例慢性腹腔感染病人随机分为GH组（TPN GH）和对照组（TPN）,研究时间为10天。分别于研究前与研究结束时进行感染评分,检测血清生长激素（GH）、血清胰岛素样生长因子-1（IGF-1）、血清胰岛素样生长因子结合蛋白-3（IGFBP-3）;分别于研究前、研究第3天、第7天及研究结束时,检测血清白蛋白、前白蛋白转铁蛋白、纤维连接蛋白、C-反应蛋白;测定每天氮平衡及24h尿肌酐。结果：研究结束时GH组GH、IGF-1、IGFBP-3显著高于对照组及研究前;研究期间GH组血清白蛋白、前白蛋白、转铁蛋白、纤维连接蛋白升高,而C-反应蛋白下降;氮平衡改善,累计氮平衡显著高于对照组,而24h尿肌酐则下降。结论：重组人生长激素能促进慢性腹腔感染病人蛋白质代谢,而IGF-1在其中发挥了重要作用。     

低热量PN联合rhGH在严重腹腔感染病人的应用

目的：探讨低热量肠外营养和重组人生长激素联合应用对严重腹腔感染病人的作用。方法：我院从１９９６年８月至１９９８年１２月，对４０例严重腹腔感染伴低蛋白血症的病人、采用低热量ＰＮ，配合短程小剂量ｒｈＧＨ进行营养治疗，监测体重，血清白蛋白，转铁蛋白，肝酐身高指数，总淋巴细胞计数和计算氮平衡，并进行治疗前，后自身对照观察。     

重组人生长激素对消化道术后病人氮平衡作用的研究

目的了解重组人生长激素(rhGH)对手术后病人氮平衡的影响。方法在肠全外营养(TIN)的基础上，加用rhGH治疗消化道大中型手术后10例病人，并与同期仅用TPN治疗的10例病人做对照研究。结果1．2组病人均未获得正氮平衡，但GH组氮平衡明显改善；术后5天累积氮平衡GH组显高于对照组。2．术后3天、5天，累积尿氮的排出，对照组较GH组高，二差别有显统计学意义。3．术后1天引流氮的排出、术后3天累积引流氮的排出及平均每天引流氮的排出，GH组均较对照组低，但无显的统计学意义。结论在低氮和低热的基础上，rhGH能减轻术后病人的负氮平衡。主要是通过减少尿氮的排出而达到节氮效果，rhGH对引流氮影响不大。