纳络酮对肝性脑病的疗效及机制研究

Investigation on Therapeutic Effects and Mechanism of Naloxone on Patients With Hepatic Encephalopathy

目的 :研究盐酸纳络酮对肝性脑病疗效及机制。评价其有效性和安全性。方法 :肝性脑病 76例 ,随机分为 3组 ,A组 2 6例 ,基础治疗 +5 %葡萄糖 2 5 0ml+纳络酮 4mg ,每 12h 1次静滴 ,至患者完全清醒后纳络酮剂量减半维持 3d ;B组 2 5例 ,基础治疗 +纳络酮 2mg加入 5 %葡萄糖 2 5 0ml静滴 ,疗程和方法同A组 ;C组 (对照组 ) 2 5例 ,基础治疗 +常规治疗 ,每日 1次 ,疗程与A、B组相同。治疗前后测定外周血苯二氮芏卓 和血氨含量 ,并观察纳络酮对肝性脑病转归影响 ,包括神志清醒时间和数字连接试验 (NCT)及数字符号试验 (DS)。结果 :肝性脑病血清苯二氮芏卓 含量明显增加 ,且与肝性脑病程度有关。纳络酮治疗后苯二氮芏卓 含量下降程度和肝性脑病清醒时间明显优于对照组 ,同时能明显改善NCT和DS结果 ,与C组相比具有显著性差异 (P <0 .0 1)。上述结果在不同剂量纳络酮治疗的A、B组间亦具统计学意义 ,说明纳络酮剂量与肝性脑病转归有关。不良反应轻微。结论 :纳络酮对肝性脑病疗效确切。尤其纳络酮大剂量对 3～ 4级肝性脑病和中剂量治疗 1～ 2级肝性脑病更为安全。

Objective: To investigate the therapeutic effects and mechanism of naloxone (NX) on patients with hepatic encephalopathy (HE), and evaluate its efficacy and safety. Methods:Seventy-six patients with HE were divided into 3 groups. Group A (26 cases) were given basal treatments plus 5% Glucose 250 ml with NX 4 mg intravenously every 12 hours. The dose of NX was halved and maintained for 3 days after patients regained conciousness. Group B (25 cases) were given basal treatments plus 5% Glucose 250 ml with NX 2 mg intravenously, the course and method of treatment were the same as group A. Groups C (25 cases) were given basal treatments with normal saline every day as control group, the course of treatment is the same as the other 2 groups. Number connection test (NCT) and digit symbol test (DS), serum levels of NH_3 and benzodiazepine were determined in all patients before and after treatment. The clinical mental status was also observed. Results: Serum levels of NH_3 and benzodiazepine increased markedly in HE and correlated with the severity of HE. The decreased serum NH_3 level and the time of regaining consciousness were superior compared to that in the control group. NX improved the result of NCT and DS. Comparing to group C, there was a significant difference (P<(0.01)). There was a statistic difference in the dosage and the effect of NX between group A and group B. The dosage of NX is correlated with the recovery of HE, and the side effects were slight. Conclusion: NX is a beneficial agent in treatment of HE,especially high dose NX for Ⅲ～Ⅳ° HE and moderate dose for Ⅰ～Ⅱ° HE are safe and effective.