生长激素治疗对烧烫伤小儿生长发育的影响

目的：评价短期应用重组人生长激素（rhGH）对小儿烧烫伤的治疗效果及治疗后对其生长发育的影响。方法：选取82例住院烧烫伤患儿，随机分为rhGH治疗组58例和对照组24例。rhGH治疗组在常规治疗的基础上给予rhGH皮下注射0．3IU／kg，每晚1次，连续使用10d。对照组只给予常规治疗，于相应时间皮下注射2m1生理盐水。另选30例发育正常的整形患儿作为正常对照。动态观察应用rhGH（或生理盐水）前1d、应用后5d后，出院时及出院后6、12、18、24个月两组患儿血生长激素、血糖水平；患儿于入院时测量身高、体重，计算体质指数（BMI），出院后6～24个月进行追踪性观察，与同时期同年龄段北京市正常小儿生长指标进行对比，评价影响。结果：rhGH治疗组创面愈合速度较对照组明显加快；创面愈合后瘢痕增生及痛痒程度明显轻于对照组，差异有显著性（P〈O．05）。rhGH治疗前两组血生长激素水平均明显低于正常水平。rhGH治疗第5天患儿的生长激素水平明显高于正常组水平和对照组（P〈0．001），至出院时两组均趋于正常。伤后两组血糖水平均有轻度升高，激素治疗第5天恢复正常，但差异无显著性，两组之间各时间比较差异均无显著性。两组出院时体重和BMI均低于北京市儿童正常标准，但两组间身高、体重和BMI差异均无显著性。结论：临床短期小剂量使用生长激素治疗小儿烧烫伤能够加速创面愈合，提高创面愈合质量。创面愈合后小剂量短期应用的生长激素不会对小儿的生长发育造成后续影响。

Late effects of recombinant human growth hormone therapy on the growth of burned children

Objective： To observe the therapeutic effect of recombinant human growth hormone （rhGH） and its late effect on growth in burned children. Methods：Eighty-two burned children aged from 2 to 13 years, with over 30% total body surface area （TBSA） and 10% full-thickness burns, were randomized in a double-blind study. On the basis of routine therapy, 58 cases were treated with rbGH 0.3 IU/kg given hypodermically once a day from day 1 to day 10. Another 24 burned inpatient children with similar extent of burn injury served as the control, they were treated with the routine method, and 2 ml normal saline was given hypodermically as a placebo from hospitalization day 3 to day 13. The excised burn wounds were closed with microautograft and allograft skin. Blood samples were collected for measuring the levels of growth hormone （GH） and blood glucose on 1 day pretreatment and 5 days after treatment, the day of leaving hospital, and 6-, 12-, 18-, 24-months after leaving hospital. In 58 burned children treated with rhGH, the body height and weight were measured, BMI was calculated, and they were compared to those of the normal children of the Beijing city. Results：The burn surface healed earlier in children treated with rhGH than that of the controls. The degree of scar hyperplasia and the feeling of pain and itch were milder in rhGH treatment group than those of the control group. The concentration of blood GH in both groups before the administration of rhGH was lower than that of physiological values. However, the concentration of GH in the rhGH group was significantly higher than that of normal values on day 5 after rhGH treatment, while a lower level than normal value was still observed in the control group （P〈0.05）. The GH levels in both groups reached normal value at the time they left hospital. The concentration of blood glucose tended to increase just after the thermal injury, and soon it became normal on rhGH administration day 5, but the difference between two groups was significant statistically. Even with the administration of rhGH, the body weight, and BMI were still lower than that of standard levels on the discharge day in both groups, there was no difference in height,body weight, and BMI between the two groups at every time point （P〉0.05）. Conclusion：Small dosage of rhGH for a short course exerts a beneficial effect on wound healing in children with thermal injury, and there is no late effect on children＇s growth.