| IntroductionConvalescence after cardiac surgery under cardiaopulmonary bypass(CPB) is characterized by a period of fatigue (postoperative fatigue POF). lt isa symptom complex of muscular weakness (including respiratory muscularweakness, hard to exclude phlegrn, resuIting in the time of taking off machinediffcultily), increased need for sleep, decreased ability to concentfate, andoften some degree of depression, lasting of some days to some months. That iscaIled as the postoperative fatigue syndrome (POFS).these changes aremediated by the endocrine-mCtabolic response to the degree of surgicaltTauma and stYess, impaired nditional ifltake or immobilization. Thishypercatabolism is not only relatCd to insufficieot edrieots suPplemeot causedby postoperative fast,more imPortanly, it is also closely related tO thosesubstances produced by neuroendocrinal and immune system under surgicalstress. Catabolism of body protein mass after open heart surgery alwaysrelated to negative nitrogen balance, hypoproteinemia, weight loss andcausing complications. Support of commonly nutfition can provide sufficientnOttieflts, bat it can not alter the hypercatabolic statC, so can't stop thebreakdown of the protein and reverse negatve nitrogen balance, and also can'treduce the POFS. Growth hormone (GH) is an anabolic hormone,recommbinant human GH (rhGH) has all the biological activities of thenatural GH, it can improve protein synthesis and reverse negative nitrogenbalance. We carried out a placebo-contro1led randomized doubIe-blind trialwith 36 patients after cardiac surgery under CPB (placebo, or contro1 group,n=l8; rhGH-treated group, n=l8). The aim of this study is to determine ifadministering domestic rhGH can prevent the development or reduce theduration of the POFS.MaterialThe 36 patients in this study were treated in our cardiaothorcic surgicaldepartment from July 2000 to Apr. 200l. All individuals had clinicaldiagnosis and indications for cardiac operation. Patients were randomlydivided (double-b1ind tria1) into two groups: (l) group A (rhGH-treated group),(2) group B (control group),l8 cases in each group.GrouP Af Ages vary from I8 to 64, average 39.44 years old; male/female =7/11; diagnosis liSted as: allial sePtal defeCt (ASD) 6 cases, rheamaticheeaart disease (mitral valvular lesion) 5 cases, rheamatic heeaart disease(combined valvular lesions) 4 cases, cardiomyxoma lcase,others 2 cases.Group B: Ages vary from l8 to 64, average 33.89 years old; male/female =7/l 1; diagnosis listed as f atrial septal defect (ASD) 7 cases, rheamaticheeaart disease (mitral valvular lesion) 4 cases, rheamatic heeaart disease(combined valvular lesions) 4 cases, cardiomyxoma lcase,others 3 cases.MethodsThe patienis were allowed to eat freely preoperatively. During thetfeattheflt period (1,, tO 7th days after the operation), each patieflt were stTict toitttake the food that was fOrm nuritional depallment.The patients in group A were received subcutaneous injection of 9 IUrhGH('jing lei"rhGH) daily from the l,t to 7th days postopefatively. From the8th day postoperatively,the patients were allowed to eat freelyOnce preoperatively and on day 4 and day 8 after the cardiac operation,each patieot were measured for height, weight on the same scale, tricepsskinfold (TSF) was measured with a Harpender skinfold caliper and mid armcircumference (AC)with a taPe by the same investigator. Arm musclecircumference (AMC)=AC-(3.14 X TSF). Urine were col1ected every 24hours on the dayl,2,3,5,7 postoperatively, to be analyzed fOr 24 hours ureanitrogen excretion. Daily nitrogen balance was calculated. [Nitrogenbalance=nitrogen intake-(24 hours urine urea nitYogen+3)]. Venous bloodsampIes were obtained to be analyzed for blood chemistry parameters(including albumin. total protein and glucose ); prealbumin (PA), transferrin(TFN) and retinol binding protein (RBP); the level of growth hormone(GH),both pr...
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