EFFECTS OF SHORT-TERM RECOMBINANT HUMAN G ROWTH-HORMONE ADMINISTRATION ON THE UREA PRODUCTION-RATE OF PATIENTS IN THE EARLY POSTOPERATIVE PERIOD

Objective: To determine the effect of short-term recombinant human gro wth hormone (rhGH) administration on urea production rate (UPR), N bal ance and aminograms. Design: Prospective, double-blind placebo-control led study. Setting: Intensive care unit of a University Hospital. Pati ents: 20 adult patients after major abdominal surgery. Interventions: Postoperative substitution of rhGH (Saizen(R), Serono, Aubonne, CH) in a dose of 0.15 IE/kg BW for 3 days. The serum levels of hGH, insulin- like growth factor-1 (IGF-1), ACTH and cortisol were measured as well as the amino acids in plasma. The degree of catabolism was calculated according to Woolfson's formula, which is based on the UPR, and by cal culation of the cumulative N balance. Results: With exception of proli ne, the plasma amino acids between the groups receiving active substan ce and total parenteral nutrition (TPN) and those receiving placebo an d TPN did not differ significantly. Neither was there a significant di fference between the groups for any other parameter measured. The UPR and IGF-1 levels showed only a tendency towards higher values as compa red with the placebo group (UPR verum group, values in g/day: 1st meas urement, 29.8 +/- 16.7; 2nd measurement, 28.3 +/- 17.7; 3rd measuremen t, 32.1 +/- 19.1; 4th measurement, 33.1 +/- 21.2. UPR placebo, values in g/day: 1 st measurement, 32.6 +/- 23.9; 2nd measurement, 30.8 +/- 1 7.9: 3rd measurement 41.6 +/-28.7: 4th measurement, 47.3 +/- 29.5. IGF -1 verum group, values in nmol/l: 1st measurement, 25.7 +/- 19.2; 2nd measurement, 44.8 +/- 23; 3rd measurement, 52.4 +/- 30; 4th measuremen t, 54.3+/- 20. IGF-1 placebo, values in nmol/l: 1st measurement: 22.9 +/- 11.7; 2nd measurement, 37.0 +/- 19.4, 3rd measurement, 38.4 +/- 21 .4: 4th measurement, 40.0 +/- 23.0). The ACTH-cortisol axis was only s lightly depressed in the group receiving active substance. Conclusions : We conclude that short-term rhGH administration over 3 days is not c apable of significantly reducing the UPR in postoperative patients, bu t we cannot exclude a significant difference between rhGH group and pl acebo after a longer administration period.