TPN加重组人生长激素对手术创伤病人治疗作用的研究

目的：了解人生长激素对手术创伤病人的治疗作用。方法：采用ＴＰＮ加重组人生长激素（ｒｈＧＨ组）治疗２３例中重度创伤病人,并与同期仅用ＴＰＮ治疗病人作对照。结果：①ｒｈＧＨ组感染率下降,平均住院日（１２．９±４．１天）与对照组比（１６．１±６．１天）有显著性差异（Ｐ＜０．０５）;②ｒｈＧＨ组术后７天血浆白蛋白浓度明显回升（３４．２７±３．２６）ｇ／Ｌ,而对照组仅升至（３１．９２±３．０１）ｇ／Ｌ,两组比较差异显著（Ｐ＜０．０５）;③术后３天和７天ｒｈＧＨ组均获得较好正氮平衡,与对照组比较差异显著;④ｒｈＧＨ组对疲劳的主观感觉普遍较对照组好,术后下床早、活动增加。结论：ｒｈＧＨ能有效改善病人负氮平衡,提高血浆白蛋白浓度,合理调节脂肪和糖的利用,加速病人康复     

重组 生长激素对腹腔感染后低白蛋白血症的防治作用——实验与临…

本研究旨在探讨重组人生长激素（ｒｈＧＨ）对腹感染引起的低白蛋白血症的治疗作用。分别在体外实验、动物实验和临床研究中，观察ｒｈＧＨ对白蛋白ｍＲＮＡ表达和白蛋白合成的影响。结果示ｒｈＧＨ明显促进体外培养肝细胞白蛋白基因表达；在内毒素损伤的肝细胞模型中，ｒｈＧＨ能显著减轻内毒素介导的白蛋白ｍＲＮＡ表达抑制。在体内，ｒｈＧＨ明显促进正常大鼠和腹腔感染大鼠肝脏白蛋白ｍＲＮＡ表达。在ＴＰＮ的基础上，ｒｈＧＨ明     

重组人生长激素在肠瘘伴低白蛋白血症病人中前瞻性应用研究

本研究前瞻性观察重组人生长激素（ｒｅｃｏｍｂｉｎａｔｅｄｈｕｍａｎＧｒｏｗｔｈＨｏｒｍｏｎｅ，ｒｈＧＨ）在肠外瘘伴低白蛋白血症病人的作用。选择１９９５年１２月～１９９７年６月间住院的肠瘘伴低白蛋白血症（＜３０ｇ／Ｌ）病人３０例，随机分为对照组１５例和ｒｈＧＨ组１５例，重组人生长激素（瑞士，Ｓｅｒｏｎｏ产品）４Ｕ×３／ｄ，肌肉注射，连续７天。实验前（０天）、实验第４和第８天，测定病人体重、血生化、血浆蛋白。结果示（１）两组病人治疗后体重均无明显的变化（Ｐ＞０．０５），两组病人的血糖、血清肌酐、ＡＫＰ、ＡＬＴ和总胆红素亦无明显差异。（２）ｒｈＧＨ组第８天的血清白蛋白浓度（３５．４±４．５ｇ／Ｌ）显著高于治疗前（２８．７±３．０ｇ／Ｌ）（Ｐ＜０．０１），而对照组血清白蛋白浓度无显著提高（Ｐ＞０．０５）。在实验第８天ｒｈＧＨ组的血清白蛋白浓度（３５．４±４．５ｇ／Ｌ）显著高于对照组（２９．１４±３．０ｇ／Ｌ）（Ｐ＜０．０５）。（３）ｒｈＧＨ组病人治疗后血清前白蛋白浓度（４．５±１．８ｇ／Ｌ）显著高于治疗前（２．９±１．７ｇ／Ｌ）和对照组（Ｐ＜０．０１）。（４）ｒｈＧＨ组病人治疗后血清转铁蛋白浓度显著高于治疗前和对照     

rhGH对手术前后24小时尿BUN排出量的影响

外科手术使病人因应激而处于蛋白质高分解状态 ,导致病人负氮平衡 ,这对病人术后康复极为不利。因此减少蛋白质分解、促进其利用是改善病人预后的重要环节。为此我们观察了手术前后病人2 4ｈ尿ＢＵＮ排出量以及基因重组生长激素 (ｒｈＧＨ )对其影响 ,报告如下。一、临床资料1.本组 12例。随机分为常规组和ｒｈＧＨ组 ,每组 6例。常规组男 5例 ,女 1例 ,年龄 36～ 58岁 ,平均 4 6岁。所患疾病与术式为 :门静脉高压症门奇静脉断流术 1例、直肠癌根治术 1例、胃癌根治术 3例、胃大部切除术 1例。ｒｈＧＨ组均为男性 ,年龄 36～ 6 8岁 ,平均 50…     

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。     

生长激素强化的TPN对创伤后细胞因子变化的影响

目的;了解生长激素（ＧＨ）强化的ＴＰＮ对创伤后细胞因子变化的影响,以探讨生长激素促进蛋白质合成作用的可能机制。方法：在手术创伤后病人采用ＴＰＮ加ＧＨ治疗１６例并与单纯ＴＰＮ治疗组进行对照,比较创伤应激后血清细胞因子和急性相蛋白水平的变化。结果：试验组在创伤应激后第４天,第６天的血清ＴＮＦ－α,ＩＬ－６和ＣＲＰ水平均显著地低于对照组。     

生长激素加营养支持在外科的应用

本文综述了近年来重组人生长激素在外科领域的应用，重点阐述了ｒｈＧＨ作为危重病人营养支持的辅助治疗，在促进蛋白质合成，创伤愈合和抗炎症作用，以及可能的作用机制。     

低热量肠外营养加生长激素对严重应激和重度营养不良病人的治疗体会

目的：观察生长激素加强危重病人应用全肠外营养支持的效果。方法：对严重应激（７例）和重度营养不良（９例）共１６例病人采用低热量肠外营养加重组生长激素联合治疗，并与仅用ＴＰＮ治疗的同类病人作对照研究，治疗后分别测定体重、血清白蛋白，前白蛋白和转铁蛋白及免疫球蛋白，计算氮平衡，观察精神状态。结果：治疗组比对照组在氮平衡、前白蛋白和转铁蛋白有明显改善（Ｐ＜０．０１），血清白蛋白，免疫球蛋白亦有明显增高（Ｐ＜０．０５），精神状态普遍较好，获得了较好的临床疗效。结论：低热量肠外营养加重组生长激素联合治疗是机体病理状态下一种较为理想的营养支持方法     

老年病人腹部大手术后应用重组人生长激素的临床观察

本文探讨老年手术病人腹部大手术后应用重组人生长激素对其预后的影响。作者选择40例接受腹部手术的老年病人，随机分为两组，治疗组术后第2d开始给予皮下注射重组人生长激素(rhGH)4IU2次／d，连续5d，观察患者在蛋白质代谢、免疫球蛋白水平、切口愈合情况及感染发生率、术后疲倦程度和精神状态的变化。结果表明治疗组术后蛋白质合成加快，负氮平衡得到改善，免疫球蛋白水平提高，术后切口愈合情况，感染发生率及疲倦程度与对照组比较均有显著差异。认为重组人生长激素的应用对老年病人手术后的良好预后有着肯定的疗效。     

肠营养素对小肠粘膜上皮细胞分化的影响

目的：探讨表皮生长因子（ＥＧＦ）、碱性成纤维细胞生长因子（ｂＦＧＦ）、胰岛素样生长因子－１（ＩＧＦ－１）、Ｌ－谷氨酰胺（Ｇｌｎ）、精氨酸、重组人生长激素（ｒｈＧＨ）和胰岛素对原代培养的小肠粘膜上皮细胞分化的影响。 方法：孕龄１７￣１９天Ｗｉｓｔａｒ系孕鼠胎仔小肠制备成小肠绒毛细胞团悬液，培养４８ｈ后加入上述肠营养素，通过测定ＡＬＰ活性观察不同剂量肠营养素对贴壁生长的肠上皮细胞分化的作用。 结果：当     

生长激素在高龄病人腹部手术后的应用

目的:探讨高龄病人腹部手术后生长激素的应用. 方法:将近2年我院收治26例腹部手术的高龄病人随机分为治疗组及对照组,于手术后第2天开始,每天皮下分别注射重组人生长激素8 U或等渗盐水2 ml,连续7天,并应用肠外营养.术前及术后第3、8天测体重、血清清蛋白、右手握力、睡眠时间及拆线天数. 结果:术后血清清蛋白水平提高、体重增加、右手握力及睡眠时间的恢复,实验组均明显优于对照组(P<0.01).拆线时间实验组也短于对照组. 结论:生长激素能使高龄病人蛋白质合成增加,促进切口愈合,并可减轻术后疲劳综合征.     

重组人生长激素与肠外营养支持在腹部外科危重病人的应用

目的 :探讨重组人生长激素 (rhGH)与肠外营养支持 (PN)在腹部外科危重病人治疗中的作用。　方法 :随机选择有严重创伤、感染并伴有低白蛋白血症 (<30g/L)的腹部外科危重病人 4 0例 ,2 0例为对照组 (PN) ,2 0例为实验组 (rhGH PN) ,观察治疗前后病人氮平衡及血浆蛋白的变化。　结果 :对照组和实验组治疗干预后 ,负氮平衡均逐渐减少 ,与对照组相比 ,实验组负氮平衡减少更为明显 (P <0 .0 5 ) ,治疗后第 5天达到正氮平衡。治疗前两组病人血清蛋白指标无明显差异 ,治疗后均升高 ,而实验组血清蛋白水平明显高于对照组 (P <0 .0 5 ) ,二者差异显著。　结论 :rhGH与PN联合应用可明显纠正负氮平衡 ,促进蛋白质合成 ,因而必将成为危重病人营养支持的理想方法。     

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。     

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。     

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.     

低热量肠内营养联合生长激素在胃肠道肿瘤患者术后的应用

目的探讨低热量肠内营养联合重组人生长激素(rhGH)对胃肠道肿瘤患者术后蛋白质代谢的影响及其治疗效果。方法将2003年1月～2005年7月在我科行胃肠道肿瘤根治术的40例患者随机分成两组:低热量肠内营养支持 安慰剂为对照组(n=20);低热量肠内营养支持 rhGH为研究组(n=20)。rhGh在术后第3天开始应用,连续应用7天。观察患者术后蛋白质代谢和血清胰岛素样生长因子-1(IGF-1)的变化情况。结果研究组术后第5天恢复正氮平衡。两组血清白蛋白、前白蛋白、转铁蛋白、纤维连接蛋白、IGF-1在术后第3天均显著下降,治疗后有不同程度的恢复。研究组术后第10天前白蛋白、转铁蛋白、纤维连接蛋白和IGF-1显著高于对照组(P<0.05)。结论低热量肠内营养支持联合rhGH能促进胃肠道肿瘤患者术后的蛋白质合成,改善患者营养状况。     

The mode of delivery of parenteral multivitamins influences nutrient handling in an animal model of total parenteral nutrition

BACKGROUND: Very low birthweight preterm infants receive early total parenteral nutrition (TPN) to optimize protein balance. Adding multivitamins (MVP) to the lipid emulsion (MVP+LIP) rather than to the amino acid+dextrose moiety of TPN (AA+MVP) limits the effects of light exposure on lipid peroxidation and vitamin loss. AIM: Compare the effects of the mode of delivery of MVP on nutrient handling and indices of oxidant stress. METHODS: Three-day old guinea pig pups were assigned to TPN containing MVP+amino acids+dextrose+heparin and electrolytes, with lipids provided separately (AA+MVP). Solutions were light exposed (LE, n = 8) or light protected (LP, n = 9). In a further group (n = 7), MVP was co-administered with the lipid moiety and light exposed (LIP+MVP). Variables measured in urine (creatinine, nitrogen, vitamin C) and in liver (protein, glutathione, isoprostane, vitamins A, E, C) were compared by ANOVA. RESULTS: Urinary nitrogen and vitamin C were higher (P<0.05) during LE, while hepatic levels of vitamin C were higher (P<0.05) with LIP+MVP. These results were not related to total peroxide levels in TPN or to markers of oxidant stress. CONCLUSION. Co-administration of MVP with lipid or light protected amino acids offers comparable beneficial effects on nitrogen and vitamin C metabolism.     

The effect of glutamine-supplemented total parenteral nutrition on nitrogen economy depends on severity of diseases in surgical patients

BACKGROUND: Gln is an important substrate for enterocyte and rapid proliferation cells. Studies have shown that parenteral supplementation of Gln maintains the intracellular Gln pool, improves nitrogen balance and shortens hospital stay. However, some studies showed Gln-supplemented TPN had no effect on restoring the Gln pool in critically ill patients. OBJECTIVE: To evaluate the effect of glutamine (Gln) dipeptide supplementation of total parenteral nutrition (TPN) on postoperative nitrogen balance and immune response of patients undergoing surgery. METHODS: This study is a prospective, randomized double-blind clinical trial. APACHE II score and TISS were used to evaluate the patients after admission. Forty-eight patients with major abdominal surgery were allocated to two groups to receive isonitrogenous (0.228 g nitrogen/kg/day) and isoenergetic (30 kcal/kg/day) TPN for 6 days. Two groups (Conv and Ala-Gln) were further divided to high (APACHE>or=6) and low (APACHE <6) groups. Control group (Conv) received 1.5 g amino acids/kg/day, whereas the Ala-Gln group received 0.972 g amino acids/kg/day and 0.417 g of L-alanyl-L-glutamine (Ala-Gln)/kg/day. Blood samples were collected on day 1 and day 6 after surgery for plasma amino acid and CD4, CD8 cell and T lymphocyte analysis. Cumulative nitrogen balance were also measured on day 2, 3, 4, 5 postoperatively. RESULTS: Although there was a tendency to have better cumulative nitrogen balance on the postoperative days in the Ala-Gln group, no significant difference was observed between two groups. However, a better significant cumulative nitrogen balance was observed on the 2nd, 3rd and 5th postoperative day in the Ala-Gln group than in the Conv group in patients with APACHE II <6, whereas no significant difference was noted in patients with APACHE II >or= 6. No difference in urine 3-methylhistidine excretion were observed between the 2 groups. Patients in the Ala-Gln group had significant higher T lymphocyte and CD4 cells than did those in the Conv group.CONCLUSION: TPN supplemented with Gln dipeptide had beneficial effect on enhancing the immune response. However, the effect of Ala-Gln administration on improving nitrogen economy was only observed in patients with low APACHE II scores. These results may indicate that Gln required for reversing the catabolic condition may depend on the characteristics and severity of the diseases.     

肠外营养与生长激素联合应用对外科大手术术后患者蛋白代谢的影响

目的观察肠外营养与生长激素联合应用对大手术术后患者蛋白代谢的影响。方法将拟实施外科大手术(四类以上手术)熏APACHE-Ⅱ评分>7分的患者30例,入院后随机分为3组熏A组穴n=10雪押肠外营养治疗与生长激素穴金磊赛增雪联合治疗组(PN+GH)鸦B组穴n=10雪押肠外营养治疗组(PN)鸦C组穴n=10雪押正常补液组。其中A组在术后第2天开始给予生长激素皮下肌注,连续7d。结果术后8d内,B、C组患者均处于负氮平衡状态,血清白蛋白与胰岛素样生长因子-Ⅰ(IGF-Ⅰ)维持较低水平,A组在术后5d机体开始恢复氮平衡,血清白蛋白与IGF-Ⅰ水平逐渐上升,A组与B、C组比较差异有显著性(P<0.05)。结论较大的外科手术打击后,单纯给予常规的肠外营养要素不能被机体有效的利用,GH能够提高机体对肠外营养要素的利用率,促进机体蛋白合成。