老年患者胸腹部术后急性呼吸衰竭机械通气应用重组人生长激素的剂量探讨

目的 探讨重组人生长激素(rhGH)治疗老年胸腹部术后急性呼吸衰竭机械通气患者的合适剂量.方法 将45例老年胸腹部术后急性呼吸衰竭机械通气患者随机分为三组(A、B、C三组),A治疗组(15例)采用rhGH 4 IU,每日1次肌肉注射,连续治疗10 d;B治疗组(15例)采用rhGH 4 IU,每日2次肌肉注射,连续治疗10 d;;C空白组(15例)无rhGH治疗.三组其他治疗相同.观察三组治疗后机械通气时间、一次拔管成功率、呼吸机相关肺炎(VAP)发生率、平均住ICU时间、ICU病死率及第10天时患者血糖含量、每日胰岛素用量.结果 与对照组相比,治疗组在机械通气时间、平均住ICU时间明显缩短(P<0.05);一次拔管成功率、VAP发生率、ICU病死率优于对照组 (P<0.05).rhGH组治疗后胰岛素的每日用量均明显高于治疗前(P<0.05),但在可控范围内.结论 rhGH在每日4IU或8IU 10天治疗老年胸腹部术后急性呼吸衰竭机械通气是安全有效的,但治疗期间应强化胰岛素治疗,防止糖代谢紊乱的发生.

A study of the dosage of rhGH on the treatment of the geratic thoracic and abdominal postoperative patients with acute respiratory failure

Objective To explore the ideal dose of rhGH on the treatment of the geratic thoracic and abdominal postoperative patients with acute respiratory failure.Methods 45 geratic surgery postoperative patients with acute respiratory failure were randomly divided into three groups(A,B,C group).Patients in rhGH group A were given rhGH 4IU twice a day for ten days continuously by intramuscular injection.Patients in rhGH group B were given rhGH 4IU once a day for ten days continuously by intramuscular injection.Patients in control group C were admitted to ICU at the same time but not given rhGH.Other treatments were same in three groups.Time of mechanical ventilation,incidence of ventilator-associatcd pneumonia(VAP),average time of in ICU,fatality rate in ICU,achievement ratio of once extubation,blood glucose in the tenth day and dosage of insulin everyday were observed and compared in the three days.Results Compare with the control group,time of mechanical ventilation and average time of in ICU in the treatment group A and B showed a statistically shorter(P<0.05);incidence of VAP,fatality rate in ICU and achievement ratio of once extubation in the treatment group A and B showed a statistically more improvement(P<0.05);dosage of insulin everyday in the treatment group A and B was more than that in control group(P<0.05),but in the controllable range.Conclusion The rhGH dose in the range of daily 4IU or 8IU for 10 days is safe for the geratic thoracic and abdominal postoperative patients with acute respiratory failure in ICU.But the monitor of blood glucose and intensive insulin therapy(IIT) should be enhanced in order to prevent glycometabolic disturbance.