Pichard C, Kyle U, Chevrolet J C, Jolliet P, Slosman D, Mensi N, Temler E, Ricou B
Division of Nutrition, Geneva University Hospital, Switzerland.
Crit Care Med. 1996 Mar;24(3):403-13. doi: 10.1097/00003246-199603000-00008.
To evaluate the benefit of recombinant human growth hormone administration on muscle strength and duration of weaning in critically ill patients undergoing prolonged mechanical ventilation.
Prospective, randomized, controlled, single-blind study.
Intensive care unit.
Twenty patients requiring > or = 7 days of mechanical ventilation for acute respiratory failure.
Random assignment to receive either 0.43 IU (approximately 0.14 mg) recombinant growth hormone/kg body weight/day (treated group), or saline (nontreated group) for 12 days.
Nutritional support was guided by indirect calorimetry. Cumulative nitrogen balance was positive throughout the study period in the treated group 17.3 (44.9 +/- 17.3[SEM] g/12 days) vs. the nontreated group (-65.8 +/- 11.8 g/12 days) (p<.0001). Despite similar initial plasma concentrations, recombinant growth hormone supplementation resulted in marked increases in growth hormone, insulin like growth factor-1, and insulin concentrations (p<.05, .02, and .0001, respectively, vs. nontreated group). Body impedance determined net fat-free mass increased in the treated group (0.8 +/- 0.6 kg) vs. the nontreated group (-1.1 +/- O.5 kg) (p<.03). Initial peripheral muscle function, assessed by computer-controlled electrical stimulation of the adductor pollicis, was similarly lower in treated and nontreated groups than sex and age-matched normal controls, and decreased further during the study period. Arterial blood gases, cumulative total mechanical ventilation time, and number of hrs/day of mechanical ventilation during weaning were similar in both patient groups. Only three of the ten patients in each group were weaned from mechanical ventilation by day 12.
Daily administration of recombinant growth hormone in mechanically ventilated patients with acute respiratory failure promotes a marked nitrogen retention. However, this reaction is accompanied neither by an improvement in muscle strength nor by a shorter duration of ventilatory supports.
评估重组人生长激素对接受长时间机械通气的危重病患者肌肉力量及撤机时间的益处。
前瞻性、随机、对照、单盲研究。
重症监护病房。
20例因急性呼吸衰竭需要机械通气≥7天的患者。
随机分配接受0.43IU（约0.14mg）重组生长激素/千克体重/天（治疗组）或生理盐水（非治疗组），共12天。
营养支持以间接测热法为指导。治疗组在整个研究期间累积氮平衡为正，为17.3（44.9±17.3[标准误]g/12天），而非治疗组为（-65.8±11.8g/12天）（p<0.0001）。尽管初始血浆浓度相似，但补充重组生长激素导致生长激素、胰岛素样生长因子-1和胰岛素浓度显著升高（分别与非治疗组相比，p<0.05、0.02和0.0001）。治疗组通过人体阻抗测定的去脂体重增加（0.8±0.6kg），而非治疗组下降（-1.1±0.5kg）（p<0.03）。通过计算机控制的拇收肌电刺激评估的初始外周肌肉功能，治疗组和非治疗组均低于性别和年龄匹配的正常对照组，且在研究期间进一步下降。两组患者的动脉血气、累积总机械通气时间以及撤机期间每天的机械通气小时数相似。每组10例患者中只有3例在第12天撤机。
对急性呼吸衰竭的机械通气患者每日给予重组人生长激素可促进显著的氮潴留。然而，这种反应既未伴随着肌肉力量的改善，也未伴随着通气支持时间的缩短。
