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目的观察添加重组人生长激素(recombinant human growth hormone,rhGH)的营养支持对严重多发伤患者营养状况的影响。方法45例严重多发伤(ISS>25)患者随机分为三组,每组15例。三组均行标准营养支持,其中两组在术后48h行添加rhGH[分别为0.2和0.4IU/(kg.d)]的营养支持14d,第三组为对照组。不同时间点测定患者氮平衡试验、血浆前白蛋白水平和安全性指标(血糖、血Na+与血总T3、T4)。结果严重多发伤患者各实验组术后第3、5天氮平衡分别为(-1.28±3.190)、(5.45±2.00)和(-0.18±2.55)、(6.11±1.60),均较对照组(-5.17±1.68)、(-1.08±3.31)明显增高(P<0.01);各实验组术后第9天、第16天的血浆前白蛋白水平分别为(180.19±27.15)、(194.44±50.82)和(194.94±29.65)、(194.11±16.17),均较对照组(117.42±19.10)、(135.63±28.31)明显增高(P<0.01)。而实验组组间比较氮平衡和前白蛋白水平在各时间点的差异无统计学意义。术后第9天、第16天安全性指标水平三组之间差异均无统计学意义。结论严重多发伤患者在术后48h添加rhGH的营养支持可显著改善其营养状况,rh-GH在0.2和0.4IU/(kg.d)剂量下应用是安全的。
Objective To observe the nutritional status of patients with severe multiple trauma by adding recombinant human growth hormone (rhGH). Methods Forty-five patients with severe multiple trauma (ISS> 25) were randomly divided into three groups (n = 15 each). The three groups were given standard nutritional support. The nutritional support of rhGH [0.2 and 0.4 IU / (kg.d)] was added to the two groups at 48 hours after operation, respectively. The third group was the control group. Nitrogen balance test, plasma prealbumin level and safety index (blood glucose, blood Na + and total blood T3, T4) were measured at different time points. Results Nitrogen balance was (-1.28 ± 3.190), (5.45 ± 2.00) and (-0.18 ± 2.55) and (6.11 ± 1.60) days on the 3rd and 5th postoperative day in each group with severe multiple trauma. Compared with the control group -5.17 ± 1.68) and (-1.08 ± 3.31), respectively (P <0.01). The levels of plasma prealbumin on the 9th day and the 16th day in each experimental group were (180.19 ± 27.15) and (194.44 ± 50.82 ) And (194.94 ± 29.65) and (194.11 ± 16.17) in the control group were significantly higher than those in the control group (117.42 ± 19.10) and (135.63 ± 28.31), respectively (P <0.01). There was no significant difference in nitrogen balance and prealbumin levels between experimental groups at different time points. On the 9th day and the 16th day after operation, there was no significant difference among the three groups in safety index. Conclusions The nutritional status of rhGH supplemented with rhGH 48 h after operation can significantly improve the nutritional status of patients with severe multiple trauma. The application of rh-GH at 0.2 and 0.4 IU / (kg.d) is safe.