Atkinson J B, Kosi M, Srikanth M S, Takano K, Costin G
Division of Pediatric Surgery, Children's Hospital of Los Angeles, CA 90027.
J Pediatr Surg. 1992 Aug;27(8):1026-8. doi: 10.1016/0022-3468(92)90551-h.
Corticosteroid (CS) administration amplifies the inhibitory effect of protein malnutrition (PM) on wound healing. Abdominal surgery in protein malnourished patients receiving corticosteroids (eg, advanced malignancy, transplant recipients) may be complicated by wound dehiscence or anastomotic breakdown. Although preoperative parenteral nutrition can reduce the incidence of these complications, this is not possible in patients requiring urgent surgical intervention. In a previous report we demonstrated that postoperative growth hormone (GH) administration could restore normal wound healing in PM rats. This study evaluates the effect of GH on wound healing in PM rats treated with CS. Forty-eight female Sprague-Dawley rats weighing 180 to 210 g were divided into four groups: (1) normally nourished; (2) PM only; (3) PM + CS; and (4) PM + CS + GH. PM rats (groups 2 to 4) received 5.5% protein chow every other day for 8 weeks. Control rats (group 1) received 23.4% protein chow for the same duration. Group 3 and 4 rats received prednisolone (2 mg/kg, intramuscularly) during the last 3 weeks of PM. All animals underwent precise 5-cm midline celiotomies. Postoperatively, rats in all groups were given 23.4% protein chow. Group 3 and 4 rats continued to receive CS postoperatively. Group 4 rats were given GH (0.5 mg/d, intraperitoneally) postoperatively for 5 days. Wound testing was performed on the 6th postoperative day after removal of the sutures. A balloon inserted into the peritoneal cavity through the vagina was gradually inflated. The pressure at which the wound disrupted was recorded as the wound bursting strength.(ABSTRACT TRUNCATED AT 250 WORDS)
皮质类固醇（CS）的使用会增强蛋白质营养不良（PM）对伤口愈合的抑制作用。接受皮质类固醇治疗的蛋白质营养不良患者（如晚期恶性肿瘤患者、移植受者）进行腹部手术时，可能会出现伤口裂开或吻合口破裂等并发症。尽管术前肠外营养可以降低这些并发症的发生率，但对于需要紧急手术干预的患者来说，这是不可能的。在之前的一份报告中，我们证明了术后给予生长激素（GH）可以恢复PM大鼠的正常伤口愈合。本研究评估了GH对接受CS治疗的PM大鼠伤口愈合的影响。将48只体重180至210克的雌性Sprague-Dawley大鼠分为四组：（1）营养正常组；（2）仅PM组；（3）PM + CS组；（4）PM + CS + GH组。PM大鼠（第2至4组）每隔一天接受5.5%蛋白质含量的食物，持续8周。对照大鼠（第1组）在相同时间段内接受23.4%蛋白质含量的食物。第3组和第4组大鼠在PM的最后3周接受泼尼松龙（2毫克/千克，肌肉注射）。所有动物均进行精确的5厘米中线剖腹手术。术后，所有组的大鼠均给予23.4%蛋白质含量的食物。第3组和第4组大鼠术后继续接受CS治疗。第4组大鼠术后给予GH（0.5毫克/天，腹腔注射），持续5天。在拆除缝线后的术后第6天进行伤口测试。通过阴道插入腹腔的气球逐渐充气。记录伤口破裂时的压力作为伤口破裂强度。（摘要截断于250字）
