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目的 探讨消化道肿瘤术后重组人生长激素(r-hGH)联合低热量肠外营养(HPN)的安全性、有效性及对预后的影响。方法 将消化道肿瘤患者 100 例双盲、随机分为受试组和对照组,受试组术后给予HPN 6 d,同时皮下注射 r hGH 7 d,对照组接受传统全胃肠外营养治疗 6 d;对比观察术后两组血浆蛋白水平、氮平衡、免疫功能状况、感染有关并发症、住院时间、术后生存率和复发率。结果 在进行6 d的HPN以后,两组患者生命体征、血常规、肝肾功能、血脂和全身不良反应差异均无统计学意义;术后第7天,受试组蛋白水平恢复至术前水平,IgG、IgA、IgM和CD3、CD4 下降不明显(P>0.05);对照组术后第10天蛋白水平才恢复至术前水平,IgG、IgM、CD3 和CD4 下降明显(P<0.05);术后第 7、10天,对照组前清蛋白、转铁蛋白、纤维连接蛋白浓度、IgG、IgM、CD3 和CD4 均显著低于受试组;受试组氮平衡明显优于对照组,术后第7天受试组恢复为正氮平衡,而对照组直到术后第10 天仍为负氮平衡;术后住院时间,受试组显著低于对照组(P<0.05);术后1、2和3年生存率、复发率两组患者差异无统计学意义(P>0.05)。结论 对于能手术切除的消化道肿瘤,术后短期合理剂量使用 r hGH联合HPN是安全、有效的,有利于患者术后的恢复。
Objective To investigate the safety, efficacy and prognosis of recombinant human growth hormone (r-hGH) combined with low-calorie parenteral nutrition (HPN) after gastrointestinal cancer. Methods 100 patients with gastrointestinal cancer were double-blind and randomly divided into the test group and the control group. The patients in the test group were given HPN for 6 days postoperatively and were given rhGH subcutaneously for 7 days. The control group received conventional total parenteral nutrition d. The levels of plasma protein, nitrogen balance, immune function, infection-related complications, length of hospital stay, postoperative survival and recurrence were compared between the two groups. Results After 6 days of HPN, there was no significant difference in vital signs, blood tests, liver and kidney function, blood lipid and systemic adverse reactions between the two groups. On the 7th day after operation, the histone levels returned to preoperative levels IgG, IgA, IgM, CD3 and CD4 were not significantly decreased (P> 0.05). The protein level of the control group returned to the preoperative level on the 10th day after surgery. The levels of albumin, transferrin, fibronectin, IgG, IgM, CD3 and CD4 in the control group were significantly lower than those in the test group on the 7th and 10th postoperative days. The nitrogen balance in the test group was significantly better than that in the control group After 7 days, the test group returned to positive nitrogen balance, while the control group remained negative nitrogen balance until the 10th day after operation. The postoperative hospital stay was significantly lower in the test group than in the control group (P <0.05) There were no significant differences in the 2-year and 3-year survival rates and recurrence rates between the two groups (P> 0.05). Conclusion For resectable digestive tract tumors, the short-term rational use of r hGH combined with HPN after surgery is safe and effective, which is in favor of postoperative recovery.