司坦唑醇对高营养风险危重患者氮平衡、握力及临床预后影响的研究

目的：探讨司坦唑醇对高营养风险危重患者氮平衡、握力及临床预后的影响。方法收集2014年1～6月入住该院ICU的危重患者，随机分为治疗组与对照组，在给予相同营养支持治疗方案基础上，治疗组予以患者司坦唑醇片4 mg 3次／天口服或胃肠道给药，对照组给予相应安慰剂，连续7 d。所有患者在入IC U后第1、4、7天分测定患者氮平衡、握力，在第1、4、7天及出院时留取患者血标本行肝功能监测，检测患者前清蛋白、总胆红素、谷丙转氨酶及谷草转氨酶。并统计两组患者机械通气时间，留住ICU时间，住院时间及28 d病死率。结果两组患者在年龄、体质量，入ICU时APACHE‐Ⅱ，NRS‐2002评分，28 d病死率差异均无统计学意义（P＞0．05）。治疗组机械通气时间，住ICU 时间以及住院时间与对照组相比均明显缩短（P＜0．05）。在入ICU第1天时，两组患者各项检测指标差异均无统计学意义（P＞0．05）。在第4天及第7天时，治疗组患者氮平衡、前清蛋白、握力及肝功能指标均较治疗前显著升高（P＜0．05），且高于对照组（P＜0．05）。在出院前治疗组升高的肝功能指标逐渐下降至正常范围。结论在危重患者中应用蛋白同化激素司坦唑醇，可以促进蛋白合成，减少肌肉等瘦体组织分解，改善患者临床症状，缩短住院时间与住IC U时间。但在使用中需高度关注其对危重患者的肝功能损害情况。

Effect of stanozolol on the nitrogen balance,grip strength and clinical outcomes of critical patients with high nutrition risk

Objective To investigate the effect of stanozolol on nitrogen balance ,grip strength and clinical outcomes of criti‐cal patients with high nutrition risk .Methods We enrolled patients who were admitted to the ICU of Guizhou provincial Hospital during the time period from January 2014 to June 2014 and ,as patients with high nutrition risk .Patients ,who received same base nutritional support program ,were divided into two groups .Treatment group who were treated with stanozolol administrated with gastric or jejunal tube for 7 days by 4 mg Tid .The control group whose members underwent placebo simultaneously with the treat‐ment group .The nitrogen balance ,grip strength of both groups was measured when at admitted and 4th as well as 7th day .Prealbu‐min ,total bilirubin ,alanine aminotransferase ,and aspartate aminotransferase were measured when at the same time and before leave hospital .The duration of the mechanical ventilation ,ICU stays ,hospital stays and mortality within 28 days were recorded .Results There was no statistical significance in the differences between all the indicators of the two groups at admission(P>0 .05) .The du‐ration of mechanical ventilation ,ICU stays ,hospital stays were decreased significantly in the treatment group (P<0 .05) compared to the control group .But the mortality within 28 days had no significant difference between two groups (P>0 .05) .Nitrogen bal‐ance ,prealbumin ,grip strength and liver function parameters in the treatment group were significantly higher than they were been at admitted and control group at 4th and 7th day (all P<0 .05) .Liver function parameters of treatment group gradually decreased to the normal range before discharge .Conclusion In critically ill patients treated with anabolic steroid stanozolol ,can promote protein synthesis ,reduce muscle and other lean tissue decomposition ,improve clinical symptoms ,short the length of hospital stay and ICU stay .But we should pay more attention on liver function in critically ill patients who treated with stanozolol .