胰岛素强化治疗与重组人生长激素在危重烧伤救治中的联合应用

目的 从代谢角度评估在危重烧伤患者救治中联合应用胰岛素强化治疗与重组人生长激素(rhGH)的临床价值.方法 选择2001～2007年15例重度烧伤患者,根据血糖水平而采取不同的降糖治疗措施,其中常规胰岛素加rhGH治疗组(常规组)9例,胰岛素强化治疗和rhGH联合应用治疗组(强化组)6例.两组均于伤后4天内手术切、削痂植皮,术后连续14天每晚皮下注射rhGH(0.3U/kg),常规组在静脉营养的葡萄糖注射液中按常规比例加入中性胰岛素,强化组同时给予持续静脉泵入胰岛素,动态观察两组患者血糖、血浆氨基酸谱、前白蛋白、血清K 及尿中3-三甲基组氨酸(3-MH)水平的变化.结果 强化组治疗3天后血糖、血钾、氨基酸及尿3-MH水平均显著低于常规组(P《0.05),而血浆前白蛋白水平显著高于常规组(P《0.05).结论 危重烧伤患者联合应用胰岛素强化治疗和rhGH可显著促进蛋白合成,有效控制烧伤后的高血糖反应,消除单独应用rhGH后血糖波动的副作用,有益于危重烧伤后高代谢的调节.

Combined use of recombinant human growth hormone and intensive insulin therapy in the treatment of severely burned patients

Objective To observe the effect of recombinant human growth hormone(rhGH)combined with intensive insulin therapy on the metabolism in severely burned patients.Methods From March 2001 to October 2007,15 severely burned patients were enrolled in the study,and they were categorized as rhGH combined with intensive insulin group(group I,n=6)and rhGH with insulin in ordinary dose group(group R,n=9).The excised burn wounds were closed with microautograft and allograft skin within 4 days after burn injury.Postoperatively,all patients received rhGH every night for 14 days.In group R,insulin in ordinary dose was added to glucose infusion,and in group I,an insulin pump was used to control blood glucose at 4-8mmol/L.Blood samples were collected for determination of blood glucose,K ,serum amino acid profile,and proalbumin,and urinary 3-MH were also measured.Results The concentration of blood glucose,K ,blood amino acids and urinary 3-MH in group I became lower than that in group R 3 days after surgery(P<0.05).The plasma concentration of proalbumin was higher in group I compared with that in group R 3 days after surgery(P<0.05).Conclusion The results suggest that administration of rhGH combined with intensive insulin therapy for severely burned patients after surgery can ameliorate post-burn hypermetabolism,alleviate the hyperglycemia induced by growth hormone,thus beneficial in controlling post-burn hypermetabolism.