CAJ | 학술논문

目的探讨临床低氮低热卡肠外营养(HPN)结合激素替代疗法治疗胃肠肿瘤患者的安全性和有效性.方法将100例经过手术治疗的,营养风险评分3或4的胃肠肿瘤患者随即分成2组.对照组给予标准的全肠外营养(TPN)和胰岛素.实验组除给予HPN、胰岛素外,还联合给予重组人生长激素(r-hGH)和奥曲肽.观察两组间激素水平、蛋白质代谢、免疫功能、临床疗效及不良反应的不同,对临床的效果和安全性进行评估,并随访调查预后.结果相对于对照组,HPN联合r-hGH,奥曲肽以及胰岛素治疗的实验组显著增强了患者蛋白质的合成,免疫功能和代谢性耐受,减少了感染和并发症的发生,缩短了住院时间,但未增加肿瘤复发和演进的风险.结论围手术期短期联合应用生长激素、生长抑素,胰岛素和HPN,能通过增加蛋白质的合成,提高免疫功能来减轻胃肠癌症患者术后应激反应.
목적 탐토림상저담저열잡장외영양(HPN)결합격소체대요법치료위장종류환자적안전성화유효성.방법 장100례경과수술치료적,영양풍험평분3혹4적위장종류환자수즉분성2조.대조조급여표준적전장외영양(TPN)화이도소.실험조제급여HPN、이도소외,환연합급여중조인생장격소(r-hGH)화오곡태.관찰량조간격소수평、단백질대사、면역공능、림상료효급불량반응적불동,대림상적효과화안전성진행평고,병수방조사예후.결과 상대우대조조,HPN연합r-hGH,오곡태이급이도소치료적실험조현저증강료환자단백질적합성,면역공능화대사성내수,감소료감염화병발증적발생,축단료주원시간,단미증가종류복발화연진적풍험.결론 위수술기단기연합응용생장격소、생장억소,이도소화HPN,능통과증가단백질적합성,제고면역공능래감경위장암증환자술후응격반응.
Objective The metabolic response to gastrointestinal cancer in patients undergoing surgery is associated with hypermetabolism and insulin resistance. The potential use of synergetic anabolic hormones in conjunction with hypocaloric parenteral nutrition ( HPN) has become a significant area of investigation. The current study was performed to determine the clinical efficiency and safety of combined hormone therapy in addition to HPN in gastrointestinal cancer patients. Methods One hundred patients with the nutrition risk screening ( NRS) score of 3 or 4 undergoing surgery for gastrointestinal cancer were randomized into two groups. The patients in the control group received standard total parenteral nutrition (TPN) and systemic insulin. The patients in the study group received HPN and systemic insulin in addition to the pretreatment of recombinant human growth hormone ( r-hGH) and octreotide. Clinical efficiency and safety were evaluated by the measurement of hormones and protein metabolites, immune function, clinical outcome,and adverse events. Follow-ups were performed to determine the influence on prognosis. Results Treatment with r-hGH, octreotide, and insulin in combination with HPN significantly increased protein synthesis , immune function and metabolic tolerance, decreased infectious complications, and shortened postoperative hospital stays, but did not increase the risk of tumor development and recurrence in the study group compared to the control group. Conclusion The proper short-term perioperative administration of growth hormone,somatostatin,and insulin in combination with HPN can overcome the postoperative stress response through the increase of protein synthesis to improve immune function in gastrointestinal cancer patients after surgery.