摘要
目的 探讨生长激素和生长抑素联合低热量肠外营养在重症急性胰腺炎 (SAP)并发多器官功能障碍 (MOD )的治疗效果。方法 将 41例SAP并发MOD患者随机分为受试组 (2 1例 )和对照组(2 0例 )。受试组给予低糖、低热量、低脂肪的肠外营养 ,总热量不超过 62 .9～ 83 .9kJ (kg·d ) ,供氮量为 0 .10～ 0 .12g (kg·d) ,脂肪供热不超过总热量的 40 % ;配合生长抑素 (疗程为 7～ 14d )和生长激素 (疗程为 7d)治疗。对照组接受传统TPN治疗。检测治疗前、治疗 1周后血浆清蛋白、前清蛋白、转铁蛋白、C反应蛋白浓度 ,外周血T淋巴细胞计数 ,氮平衡 ,血尿素氮浓度 ,及血液中炎症介质TNF α ,IL 1和IL 6的浓度。结果 受试组经治疗后 ,血浆中清蛋白、前清蛋白、转铁蛋白浓度显著升高(P <0 .0 5 ) ,C反应蛋白浓度则明显降低 (P <0 .0 5 ) ,负氮平衡纠正 (P <0 .0 1) ,外周血T淋巴细胞计数升高 (P <0 .0 1) ,血尿素氮生成减少 (P <0 .0 1) ,TNF α ,IL 1,IL 6过度表达明显抑制 (P <0 .0 1)。对照组治疗前后各项指标无显著变化。结论 生长激素和生长抑素联合低热量肠外营养 ,能够有效地克服SAP并发MOD患者所出现的营养代谢障碍 ,抑制炎症介质的过度表达 ,减轻高分解代谢状态 ,从而提高营养治疗效果。
Objective To evaluate the effect of combination of growth hormone(GH),somatostatin(ST) with hypocaloric parenteral nutrition(HPN) on SAP patients with MOD. Methods forty one cases of SAP complicated with MOD were randomedly divided into control group (20 cases) and experiment group (21 cases). In experiment group ,total calories and nitrogen were given 62.9～83.9kJ/(kg·d) and 0.10～ 0.12g/(kg·d). lipid calorie was supplied in less than 40 percent of the total energy.GH was percutaneously injected for 7d and ST was intravenously injected for 7～14d. Control group was given TPN only.Serum albumin, pre albumin, transferring,CRP,total lymphocyte count(TLC), urea nitrogen, nitrogen balance and serum TNF α, IL 1,IL 6 level were determined before treatment and on the day 7 after treatment. Results After treatment, serum albumin and pre albumin and transferring increased significantly (P<0.05),total lymphocyte count elevated significantly (P< 0.01 ), CRP significantly decreased(P< 0.05 ), nitrogen balance improved (P< 0.01 ),serum urea nitrogen significantly decreased (P< 0.01 ),overexpression of inflammation mediators: TNF α, IL 1 and IL 6 inhibited (P<0.01).But theindices mentioned above had no chang before and after treatment in coutrol group. Conclusions The results suggest that GH and ST combined with HPN can improve the SAP patients nutrition status, inhibit the overexpression of inflammation mediators,reduce the hypermetabdism statue and improve the effect of nutrition therapy.
出处
《中国普通外科杂志》
CAS
CSCD
2003年第2期90-93,共4页
China Journal of General Surgery
