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.     

11.4%Novamin与7%Vamin对术后病人蛋白质代谢影响的比较研究

目的：在腹部外科手术后病人肠外营养支持中行复方氨基酸液１１．４％Ｎｏｖａｍｉｎ和７％Ｖａｍｉｎ对蛋白质代谢影响的比较研究。方法：７０例病人术后１～６天进行肠外营养支持,等热量、等氮（非蛋白热量为１０５ｋＪ／ｋｇ·ｄ－１,氮量为０．１５ｇ／ｋｇ·ｄ－１）。随机分成两组,每组３５例。一组氮的供给由１１．４％Ｎｏｖａｍｉｎ提供,另一组则由７％Ｖａｍｉｎ提供。在术前和术后６天营养支持结束后,分别测量体重,测定血浆总蛋白和白蛋白浓度,分析血浆氨基酸谱。术后１～６天每天收集２４尿液和腹腔引流液等其他排出液测定氮量,并计算氮平衡。结果：两组病人术后体重、血浆总蛋白和白蛋白浓度与术前比均有下降,但组间无显著差异。氨基酸谱分析在组间比较无显著差异。氮平衡观察表明,两组术后１～６天累积氮平衡差异显著,１１．４％Ｎｏｖａｍｉｎ组为（－８２．２±２４．７）ｍｇ／ｋｇ体重,７％Ｖａｍｉｎ组为（－１７１．１±２０１．６）ｍｇ／ｋｇ体重,Ｐ＜０．０５。结论：在手术创伤后应用１１．４％Ｎｏ－ｖａｍｉｎ进行肠外营养支持比７％Ｖａｍｉｎ能进一步改善氮平衡     

胰腺癌术后早期胃肠内营养支持的效应

目的：探讨胰腺癌术后早期给予肠内营养支持（ＥＮ）对手术后代谢反应和治疗结果的影响。方法：３０例胰腺癌随机分为治疗组和对照组，分别于术后给予肠内营养支持及常规治疗，检验两组病人术后不同代谢变化。结果：治疗组在治疗前后体重变化、术后肠蠕动恢复时间、累积氮平衡方面明显优于对照组，术后并发症明显降低。结论：胰腺癌术后早期给予肠内营养给予肠内营养支持是适宜的具有显著的优点。     

谷氨酰胺双肽对腹部手术后患者负氮平衡及免疫功能的影响

目的评价谷氨酰胺双肽对腹部手术后患者负氮平衡及免疫功能的影响。方法将52例腹部手术后患者随机分为两组，分别接受超过5天的等氮、等热量的全胃肠外营养。对照组给予氨基酸1．5g·kg^-1·d^-1，研究组（Gin组）给予氨基酸1．2g·kg^-1·d^-1和L-丙氨酰-L-谷氨酰胺0．3g·kg^-1·d^-1。分别于术后第2-5天计算氮平衡，于术后第1、3、6天抽取静脉血行生化检查及游离氨基酸检查，并分析免疫球蛋白（Ig）、T淋巴细胞亚群及中性粒细胞来源的半胱氨酰白三烯的生成。结果所有患者均无不良反应发生。GIn组患者氮平衡改善优于对照组（P〈0．05）；术后6天血浆谷氨酰胺浓度，IgG、IgA，CD3、CD4和CD4／CD8以及中性粒细胞来源的半胱氨酰白三烯的生成均较对照组显著增高（P〈0．05）；术后住院时间显著缩短（P〈0．05）。结论添加谷氨酰胺双肽的全胃肠外营养对于腹部手术患者氮平衡、血浆谷氨酰胺浓度的维持、免疫功能、半胱氨酰白三烯的生成以及缩短住院时间均有积极的作用。     

重组人生长激素对术后患者营养状态的影响

目的探讨小剂量重组人生长激素对腹部手术患者营养状态的影响。方法48例需行腹部手术的患者随机分为3组，A、B组每日给予重组人生长激素皮下注射0.15U·kg－1·d-1和0．075U·kg-1·d-1，C组为对照组，以生理盐水为安慰剂。每例患者进行体重、握力、上臂中部周长、尿中尿素氮、肌酐、血中转铁蛋白及淋巴细胞总数定期测定和相关性分析。结果A组患者的体重、握力较C组显著增加（P＜0.05）；A组累积氮平衡亦明显高于对照组（P＜0.05）;其余指标无显著改变。而B组各项指标变化与对照组比较均无统计学差异。结论重组人生长激素能促进术后患者的蛋白质合成，尽快达到正氮平衡，增加患者的体重和握力，提高术后生活质量和对手术打击的耐受性，加速患者恢复，其作用与剂量有关。     

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。     

应用重组人生长激素改善高龄病人术后疲劳综合征的临床研究

目的 :探讨高龄手术病人 (6 0～ 80岁 )在充足营养底物支持下 ,应用重组人生长激素 (rhGH)能否减轻术后疲劳综合征 (POF)。　方法 :选择 4 0例接受胃大部切除术或其他手术创伤的高龄病人 ,随机分组进行双盲试验。两组病人术后给予相同标准的营养底物 ,rhGH组术后第 3天起给予rhGH 9U/d ,连续 7天。对照组给予安慰剂 ,监测病人术后疲劳度、氮平衡、转铁蛋白及体重。　结果 :于术后 7、14天rhGH组疲劳度 (Christensen评分 )低于对照组 (P <0 .0 5 ) ;排氮量明显低于对照组 (P <0 .0 0 1) ;转铁蛋白下降明显低于对照组 (P <0 .0 1) ;两组体重均有下降 ,相比无显著差异 (P >0 .0 5 )。　结论 :应用rhGH有利于减轻高龄手术病人术后POF。     

谷氨酰胺对肿瘤病人术后营养状况及免疫功能的影响

目的 探讨谷氨酰胺对肿瘤病人术后营养状况及免疫功能的影响。方法 20例胃肠道肿瘤病人术后随机分为常规TPN组（对照组）10例和TPN＋Gln组（研究组）10例，治疗8天，观察血清前白蛋白、血清转铁蛋白、氮平衡变化。并检查其前后外周血IgG、IgM、IgA、C3、C4的变化。结果 （1）两组病人负氮平衡改善，研究组与对照组比较差异明显（P＜0．01）。两组病人血清蛋白均上升，研究组回升更明显，与对照组比较具有显差异（P＜0．01）。（2）研究组外周血IgG、IgM、IgA明显升高，与对照组比较差异显（P＜0．05）。研究组C3、C4明显升高与对照组比较差异显（P＜0．05）。结论 谷氨酰胺改善了肿瘤术后病人的营养状况，提高了免疫功能。     

胃切除术后早期肠内营养的临床观察

目的 探讨胃切除术后肠内早期营养的临床疗效。方法 将36例胃切除患随机分2组,术后48h内均给于肠外营养支持,48h后I组继续行肠外营养,Ⅱ组改行肠内营养（能全力）,连续5天。肠内制剂通过置留于空肠或十二指肠降部的鼻十二指肠／空肠管。结果 术后第7天两组病人体质量（m)、上臂肌围长（AMC）、转铁蛋白（TRF）等较术前明显增加（P均＜0．05）,但两组各项指标相比差异无显性意义;两组病人术前和术后7天血浆蛋白（ALb)、前白蛋白（pALb)的值相比差异均无显性意义;Ⅱ组氮平衡比I组恢复快。结论 早期肠内营养安全有效,能更早恢复氮平衡。     

丙氨酰-谷氨酰胺双肽对接受肠外营养的外科病人氮平衡、肠粘膜通透性和预后的影响

目的 评价丙氨酰-谷塔氨酰胺双肽的临床安全性及其对手术后病人氨平衡、肠粘膜通透性和临床预后的影响。方法 接受腹部外科手术的120例病人，研究方案获得伦理委员会批准并都得到了病人的知情书面同意。采用双盲设计。二个中心的60例病人进行了临床安全性和临床预后的观察(每个中心各30例)。另外二个中心的60例病人进行了氨平衡、肠粘膜通透性、临床预后和临床安全性的观察。所有的病人都接受等氨(每天0．20g／kg BW)和等热卡(每天30kcal／kg BW)的肠外营养。研究组接受丙氨酰-谷氨酰胺双肽的补充(Dimptiven，每天0．50g/kg BW，相当于谷氨酰胺每天0．34g／kg BW)。对临床生化指标、血浆氨基酸谱、氮平衡、肠粘膜通透性(lactulose/mannitol ratio，L／M比值)进行测定。对病人的住院时间和与感染有关的并发症进行观察。统计分析采用Statview软件，进行方差分析或卡方检验，当P<0．05认为差异有显性。结果 术前研究组和对照组具有可比性。手术前(ADD3)研究组和对照组病人的L／M比值分别是0．047±0．029和0．058±0．049。在手术后第七天，研究组和对照组病人的L／M比值分别是0．097±0.063和0．132±0.081。二组Delta比较差异有显性(P=0．02)。手术后6天的累计氨平衡在研究组是144±145mg／kg，对照组是-5±162mg／kg，二组之间差异显性(P=0．004)。所有病人都没有发生切日感染，但对照组有3例病人发生了与感染有关的并发症。研究组病人的住院时间比对照组少4天(P=0．02)。结论 临床使用添加丙氨酰-谷氨酰胺双肽的肠外营养是安全的。对手术后病人．添加丙氨酰-谷氨酰胺双肽的肠外营养可以改善病人的氨平衡和维持肠粘膜通透性，对临床预后也有较好的影响。     

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.     

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。     

Nutritional and hormonal effects of biosynthetic human growth hormone in surgical patients on total parenteral nutrition.

The anabolic effects of biosynthetic human growth hormone (BHGH) were tested on 30 patients, aged 37-68 yr, divided into four groups: group 1 received surgery plus total parenteral nutrition (TPN) plus BHGH, group 2 received just surgery and TPN, Group 3 received TPN and BHGH, and group 4 received just TPN. TPN was given as an all-in-one formula (glucose 4.7 g.kg.-1day-1, amino acids 1.2 g.kg-1.day-1, lipids 0.7 g.kg-1.day-1, electrolytes and trace elements. BHGH (0.25 IU.kg-1.day-1) or placebo were administered subcutaneously at 0800 for 10 days. Nitrogen and phosphorous balance, as well as the common plasma nutritional markers (transferrin, albumin, prealbumin), triglycerides, apolipoprotein B, insulin, and cortisol were evaluated daily. Urinary creatinine loss was evaluated on days 3, 7, and 10. Cumulative nitrogen balance was better in group 1 (-16.1 +/- 3.2 g N2) than in group 2 (-33.7 +/- 4.6 g N2) (P less than 0.01), whereas the difference was nonsignificant in groups 3 and 4. Phosphorous balance and creatinine excretion paralleled nitrogen balance. Plasma markers were not significantly improved in group 1 compared with group 2; however, they were significantly better in group 3 than in group 4. Lipids were better metabolized in the BHGH-treated groups. Insulin was increased in both groups 1 and 3, whereas cortisol did not rise after surgical stress, probably because of BHGH administration. A positive effect of BHGH on nutritional status and hormonal background is suggested by these data.     

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.     

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。     

丙氨酰胺谷氨酰胺对术后化疗消化道肿瘤患者的作用

目的研究添加丙氨酰胺谷氨酰胺(Ala-Gln)的全胃肠外营养(TPN)对术后化疗消化道肿瘤患者的作用。方法30例消化道肿瘤患者,按序随机分为两组传统组和二肽组,每组15例,术后给予等热量(104.6kJ     

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。     

谷氨酰胺和生长激素对术后病人肌肉代谢的影响

目的许多研究表明,给予生长激素和谷氨酰胺能减少手术后肌肉蛋白的分解(术后肌蛋白分解表现在肌蛋白合成减少、谷氨酰胺水平降低和氮丢失增加)。本研究目的是联合使用生长激素和胰岛素样生长因子((IGF-I,一种能解释生长激素部分作用效果的生长因子)及添加生长激素和谷氨酰胺对术后肌肉代谢的影响。