重组人生长激素在严重延迟复苏病人中的应用

目的:探讨重组人生长激素(rhGH)在严重延迟复苏治疗中的作用。方法:依据应用rhGH与否,将62例严重延迟复苏病人分为rhGH治疗组(GH组,n=26)及非rhGH组(NGH组,n=36),GH组每晚20:00皮下注射重组人生长激素(rhGH,0.2~0.4IU.kg-1.d-1)进行治疗,NGH、GH两组其余治疗方案均相同。观察两组创面愈合时间,前白蛋白水平,rhGH应用前后空腹微量血糖、尿糖、血清胰岛素水平。结果:(1)GH组供皮区、植皮区、深II度、浅II度创面及创面平均愈合时间较NGH组缩短(P<0.05)。(2)两组血浆前白蛋白明显下降,以NGH组下降更为明显(P<0.05)。(3)两组空腹血糖、胰岛素水平均明显升高,但胰岛素以GH组升高更为明显(P<0.05)。(4)13例(20.9%)尿糖明显升高,尿糖阳性多为一过性。GH组中尿糖升高以≥+++为主,与NGH组比较P<0.05。结论:rhGH有助于改善严重延迟复苏烧伤患者的营养状况,促进烧伤创面及供皮区创面愈合,起到良好代谢调理和免疫调控作用。但应用时需注意存在高糖血症及尿糖升高的倾向。

Clinical Application of Recombinant Human Growth Hormone in Severely Burned Patients with Delayed Fluid Resuscitation

Objective：To investigate clinical effect of rhGH in severely burned patients with delayed fluid resuscitation. Methods： From January, 1990 through December 2000, altogether 62 cases delayed fluid resuscitation were admitted to our burn department, and divided into two groups. The patients treated with recombinant human growth hormone（rhGH） were classed as group GH, and that without treatment of rhGH were entered into group NGH. Plasma pre-albumin, insulin , blood glucose and urine glucose levels were measured immediately after hospitalization and postburn day（Pt3D）1, 3, 7, 14, 21,28. Results： （1）The wound healing time of group GH was shorter than that, of group NGH. （2）Plasrna pre-albumin levels was decreased in two groups, especially in group NGH（P〈0. 05）. （3）Plasma insulin and blood glucose levels were both increased in two groups and the plasma insulin level was more markedly increased in group GH（P〈0. 05）. Conclusion： Recombinant human growth hormone （rhGH）can improve the nutrition status and wound healing of severely burned patients with delayed fluid resuscitation. It is necessary to dynamically monitor the changes of blood glucose, urine glucose and beware of hyperglycemia after application of recombinant human growth hormone.