Effects of human growth hormone on the catabolic state after surgical trauma.
The aims of our studies were: (1) to determine if the protein catabolic response after a major or moderate surgical trauma can be restrained by the administration of exogenous human growth hormone (hGH); (2) to determine if the administration of hGH can improve systemic host defenses, thus reducing the risk of infection, and (3) given that the postoperative fatigue syndrome (POF) is mediated by the endocrino-metabolic response to surgery we attempt to determine if the administration of hGH can prevent or reduce POF. Therefore, we performed three placebo-controlled randomized double-blind trials on 216 patients. Major gastrointestinal surgery was treated only with total parenteral nutrition (TPN; n = 20) or TPN plus 4 IU hGH (n = 18). Patients with moderate surgical trauma received either hypocaloric parenteral nutrition (HPN; n = 93) or HPN and 8 IU hGH (n = 87). In this study, we also determined the evolution of the systemic host defenses and thereby the risk of infection. In 48 patients who underwent cholecystectomy treated (n = 26) either with HPN or HPN plus 8 IU hGH, we measured the protein catabolic response, postoperative fatigue and anthropometric modifications. The treatment with hGH together with HPN or TPN (1) overcomes the protein catabolic effects of the trauma response induced by major or moderate surgery by increasing protein synthesis, (2) improves humoral and cellular systemic host defenses, thus reducing the risk of infection, (3) preserves or increases lean body mass and reduces adipose tissue and (4) minimizes POF.
Vara-Thorbeck
R
R
Department Surgery, University of Granada, Spain.
Ruiz-Requena
E
E
Guerrero-Fernández
J A
JA
D000328:Adult; D000368:Aged; D000917:Antibody Formation; D003082:Colectomy; D004311:Double-Blind Method; D005221:Fatigue; D005260:Female; D005743:Gastrectomy; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D013006:Growth Hormone / Q000627:therapeutic use*; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000517:prevention & control*; D013530:Surgical Wound Infection / Q000517:prevention & control; D013577:Syndrome; D014947:Wounds and Injuries / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control
D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D013006:Growth Hormone