重组人生长激素加胃肠外营养在小儿围手术期的应用

摘要

目的 研究重组人生长激素加胃肠外营养对围手术期患儿低蛋白及免疫功能的改善及可能的机制.方法 45例胸、腹部大手术及重症患儿随机分为两组:重组人生长激素+胃肠外营养组(24例)、胃肠外营养组(21例).两组均采用周围静脉输入法给予胃肠外营养胃肠外营养支持,营养素包括碳水化合物、脂肪乳,氨基酸、维生素及微量元素,按需要的热卡计算营养素的需要量,连输5～7d,重组人生长激素+胃肠外营养组在胃肠外营养的基础上肌肉注射重组人生长激素0.1IU·kg-1·d-1.于手术前及输注结束次日测定患儿的血浆白蛋白、前白蛋白及转铁蛋白及各项免疫功能指标.结果 营养支持后胃肠外营养组的血浆白蛋白、前白蛋白及转铁蛋白有一定升高,与支持前比较,有显著性差异(t分别为2.946、3.214、3.010,均P<0.05);CD4T细胞明显增高,CD8T细胞明显降低,CD4/CD8明显增高且均具有统计学差异(t分别为2.210、2.356、2.416,均P<0.05).营养支持后重组人生长激素+胃肠外营养组与胃肠外营养组比较,血浆白蛋白、前白蛋白、转铁蛋白、IgG,IgM,补体C4均增高(t分别为2.237、2.897、3.021、2.135、2.386、2.310,均P<0.05),CD4T细胞,CD4/CD8及补体C3明显增高(t分别为2.721、2.812、2.791,均P<0.01),CD8T细胞明显降低(t =2.787,P<0.01),有显著统计学差异.结论 胃肠外营养具有一定的升高血浆蛋白及免疫增强作用.重组人生长激素加胃肠外营养应用于小儿围手术期,具有明显的促进蛋白合成和免疫增强作用,更有利于患儿安全度过围手术期,促进患儿康复,是一种可以推荐的静脉营养支持优化方案.%Objective To study the promoting effect of recombinant human growth hormone ( rhGH ) combined with parenteral nutrition ( PN ) on perioperative infants' and children' s low protein and immunologic function and the possible underlying mechanisms. Methods Forty-five cases with major thoracic surgery or abdominal operation and those with severe diseases were randomly divided into two groups,group of rhGH combined with PN ( 24 cases ) and PN group ( 21 cases ). All the cases were supplied with PN including carbohydrate, fat milk, amino acids, vitamins and microelements by peripheral venous for 5 to 7 days. The nutrient was calculated according to the requisite calorie count. Besides PN, the cases in the group of rhGH combined with PN were intramuscularly injected with 0. 1IU · kg-1 · d-1 rhGH. The plasma-albumin, prealbumin, transferrin and immunologic parameters were detected preoperatively and on the next day after finishing infusion. Results Compared with the levels before PN, the levels of plasma-albumin, prealbumin and transferrin were increased in PN group( t was 2. 946, 3. 214 and 3. 010 respectively, P ＜ 0.05. The level of CD4T was increased significantly, the level of CD8T decreased significantly and the level of CD4/CD8 increased significantly in PN group. The differences were significant ( t was 2. 210,2. 356 and 2. 416 respectively, P ＜ 0.05 ). Compared with the levels in PN group, the levels of plasma-albumin, prealbumin, transferring,IgG, IgM and complement C4 increased( t was 2. 237, 2. 897, 3. 021, 2. 135, 2. 386 and 2. 310 respectively,P ＜ 0.05 ), the levels of CD4T, CD4/CD8 and complement C3 increased significantly( t was 2. 721, 2. 812 and 2. 791 respectively, P ＜ 0.01 ), and the level of CD8 decreased significantly ( t= 2. 787, P ＜ 0.01 )in group of rgGH combined with PN. Conclusion PN plays a role in enhancing plasma protein and promoting immunological function. RhGH combined with PN can promote protein synthesis and enhance immunologic function significantly, which is helpful for infants and children to get through the perioperative period safely and is beneficial to their rehabilitation.The combination of rhGH and PN is a recommendable prioritized scheme for intravenous nutrition.