Zhengchun Mao1, Rukun Chen, Lin Zhao. 1. Department of Cardiothoracic Surgery, the 2nd Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China.
Abstract
OBJECTIVE: To observe the effect of recombinant human growth hormone (rhGH) treatment on postoperative fatigue syndrome (POFS) in patients after cardiac surgery under cardiaopulmonary bypass (CPB). METHODS:60 patients undergoing open heart surgery were randomly divided (double blind trial) into two groups : group A (injected with rhGH, 4.5 U Bid for 5-7 days) and group B (administrated with placebo). The patients were asked to score their sense of fatigue (Christensen scores). Their 24-hour urine was collected to calculate the daily nitrogen balance. The serum growth hormone (GH) and plasma proteins were detected. RESULTS: In the 4(th) day after operation, the level of fatigue was increased significantly in both groups, however, being lower in group A then in group B, and returned to the pre- operative level in the 8(th) postoperative day in group A (P < 0.01 ). The serum GH was similar in both groups before operation and was significantly increased on the first, fourth, and eighth days, especially the first day, postoperatively in group A (P < 0.01). The plasma total protein and albumin were similar in both groups before operation and on the first and fourth days postoperatively. On the 8(th) day postoperatively the plasma TP and albumin were significantly higher in group A than in group B (P < 0.05 and P < 0.01 respectively). The plasma retinol binding protein (RBP), prealbumin (PA), and transferrin (TFN) were similar in both groups before operation, on the first day after operation the plasma PA and TFN were lower than before operation in both groups. On the first postoperative day, the plasma RBP was higher in group A than in group B (P < 0.05), on the fourth day after operation the plasma PA and TEN were significantly higher in group A than in group B (P < 0.01). The time needed to wean from mechanical ventilation was 15.44 +/- 5.66 hr and 22.66 +/- 10.66 hr in groups A and B respectively (P < 0.01). In group A four patients established positive nitrogen balance on the second postoperative day and all patients in group B failed to obtain positiver nitrogen balance till the seventh postoperative day (P < 0.01). CONCLUSION: 1) Application of exogenous rhGH improves the symptoms of POFS, reduce the duration of POFS, and shorten the time needed to wean from mechanical ventilation, elevate plasma albumin, PA, TFN and RBP levels, and improve negative nitrogen balance. 2) The acute phase plasma proteins (such as PA, TFN, and RBP) are reliable biochemical indicators of POFS.
RCT Entities:
OBJECTIVE: To observe the effect of recombinant humangrowth hormone (rhGH) treatment on postoperative fatigue syndrome (POFS) in patients after cardiac surgery under cardiaopulmonary bypass (CPB). METHODS: 60 patients undergoing open heart surgery were randomly divided (double blind trial) into two groups : group A (injected with rhGH, 4.5 U Bid for 5-7 days) and group B (administrated with placebo). The patients were asked to score their sense of fatigue (Christensen scores). Their 24-hour urine was collected to calculate the daily nitrogen balance. The serum growth hormone (GH) and plasma proteins were detected. RESULTS: In the 4(th) day after operation, the level of fatigue was increased significantly in both groups, however, being lower in group A then in group B, and returned to the pre- operative level in the 8(th) postoperative day in group A (P < 0.01 ). The serum GH was similar in both groups before operation and was significantly increased on the first, fourth, and eighth days, especially the first day, postoperatively in group A (P < 0.01). The plasma total protein and albumin were similar in both groups before operation and on the first and fourth days postoperatively. On the 8(th) day postoperatively the plasma TP and albumin were significantly higher in group A than in group B (P < 0.05 and P < 0.01 respectively). The plasma retinol binding protein (RBP), prealbumin (PA), and transferrin (TFN) were similar in both groups before operation, on the first day after operation the plasma PA and TFN were lower than before operation in both groups. On the first postoperative day, the plasma RBP was higher in group A than in group B (P < 0.05), on the fourth day after operation the plasma PA and TEN were significantly higher in group A than in group B (P < 0.01). The time needed to wean from mechanical ventilation was 15.44 +/- 5.66 hr and 22.66 +/- 10.66 hr in groups A and B respectively (P < 0.01). In group A four patients established positive nitrogen balance on the second postoperative day and all patients in group B failed to obtain positiver nitrogen balance till the seventh postoperative day (P < 0.01). CONCLUSION: 1) Application of exogenous rhGH improves the symptoms of POFS, reduce the duration of POFS, and shorten the time needed to wean from mechanical ventilation, elevate plasma albumin, PA, TFN and RBP levels, and improve negative nitrogen balance. 2) The acute phase plasma proteins (such as PA, TFN, and RBP) are reliable biochemical indicators of POFS.