Felbinger T W, Suchner U, Goetz A E, Briegel J, Peter K
Clinic for Anesthesiology, Ludwig-Maximilians-Universität, Klinikum Grosshadern, Munich, Germany.
Crit Care Med. 1999 Aug;27(8):1634-8. doi: 10.1097/00003246-199908000-00043.
To investigate the effects of recombinant human growth hormone (rHGH) as a "rescue treatment" in an end-stage chronic obstructive pulmonary disease patient after prolonged weaning failure.
Descriptive case report.
Fifteen-bed intensive care unit in a university hospital.
A 62-year-old man with end-stage chronic obstructive pulmonary disease and pulmonary emphysema after lung reduction surgery and prolonged weaning failure after long-term mechanical ventilation.
After 42 days of unsuccessful weaning from the respirator, rHGH (27 IU/day, 0.3 IU/kg body weight/day) was administered for 20 days through a subcutaneous injection in addition to standard intensive care.
In addition to daily routine laboratory studies, the visceral proteins prealbumin, retinol-binding protein, and transferrin, and nitrogen balance were measured twice a week, as were the thyroid hormones triiodothyronine, thyroxine, and thyroid-stimulating hormone, plasma insulin levels, and the insulin-like growth factor (IGF)-1 binding proteins IGF-BP1 and IGF-BP3. IGF-1 was measured from day 1 to day 4 of rHGH administration. Nutritional support was guided by indirect calorimetry. Additionally, weaning variables such as peak expiratory flow rate and expiratory tidal volume were measured noninvasively. T-piece weaning trials were carried out daily until respiratory muscle fatigue occurred. IGF-1 increased in response to rHGH stimulation, from 103 to 230 microg/mL, within 4 days. The carrier protein IGF-BP3 increased from 126 to 283 mg/L at the end of the study period, and the inhibiting IGF-BP1 decreased initially from 19 to 14 mg/L and then increased until the end of the study to 31 mg/L. Nitrogen balance increased initially from 4.6 to 13.6 g/24 hrs and thereafter decreased until the end of rHGH treatment to 8.3 g/24 hrs. Resting energy expenditure increased from 1800 to 2300 kcal/24 hrs. Peak expiratory flow rate increased from 0.69 to 0.88 L/sec. The expiratory tidal volume showed a slight increase during the study period during the daily decrease of pressure support on the ventilator setting. Respiratory muscular strength increased beginning 10 days after rHGH therapy was started. From this point, T-piece weaning trials could be prolonged almost daily. The patient was extubated successfully on postoperative day 75.
This case report shows that after a prolonged catabolic state and long-term mechanical ventilation, administration of rHGH not only enhances the response of protein metabolism but improves respiratory muscular strength. Therefore, it may reduce the duration of mechanical ventilation in selected patients.
探讨重组人生长激素（rHGH）作为“挽救治疗”对一名长期撤机失败的终末期慢性阻塞性肺疾病患者的影响。
描述性病例报告。
一所大学医院的拥有15张床位的重症监护病房。
一名62岁男性，患有终末期慢性阻塞性肺疾病和肺气肿，接受了肺减容手术，长期机械通气后撤机失败时间较长。
在尝试从呼吸机撤机42天未成功后，除标准重症监护治疗外，通过皮下注射给予rHGH（27 IU/天，0.3 IU/千克体重/天），持续20天。
除每日常规实验室检查外，每周两次测量内脏蛋白前白蛋白、视黄醇结合蛋白和转铁蛋白以及氮平衡，同时每周两次测量甲状腺激素三碘甲状腺原氨酸、甲状腺素和促甲状腺激素、血浆胰岛素水平以及胰岛素样生长因子（IGF）-1结合蛋白IGF-BP1和IGF-BP3。在给予rHGH的第1天至第4天测量IGF-1。营养支持以间接测热法为指导。此外，无创测量诸如呼气峰值流速和呼气潮气量等撤机变量。每天进行T形管撤机试验，直至出现呼吸肌疲劳。IGF-1在rHGH刺激后4天内从103微克/毫升增加至230微克/毫升。载体蛋白IGF-BP3在研究期末从126毫克/升增加至283毫克/升，而具有抑制作用的IGF-BP1最初从19毫克/升降至14毫克/升，然后在研究结束时增加至31毫克/升。氮平衡最初从4.6克/24小时增加至13.6克/24小时，此后在rHGH治疗结束时降至8.3克/24小时。静息能量消耗从1800千卡/24小时增加至2300千卡/24小时。呼气峰值流速从0.69升/秒增加至0.88升/秒。在研究期间，随着呼吸机设置中压力支持的每日降低，呼气潮气量略有增加。在开始rHGH治疗10天后呼吸肌力量增强。从此时起，T形管撤机试验几乎可以每天延长。患者于术后第75天成功拔管。
本病例报告表明，在长期分解代谢状态和长期机械通气后，给予rHGH不仅增强了蛋白质代谢反应，还改善了呼吸肌力量。因此，它可能会缩短特定患者的机械通气时间。
