综合降低血氨浓度治疗乙肝肝硬化引起的肝性脑病

Effects of comprehensive treatment through decreasing serum ammonia on hepatic encephalopathy in patients with hepatitis B liver cirrhosis

目的通过综合降低血氨浓度,观察治疗乙肝肝硬化引起的肝性脑病的临床疗效。方法将56例乙肝肝硬化出现肝性脑病患者随机分为综合降低血氨治疗组(包括口服乳果糖、醋酸灌肠、乙酰谷酰胺静脉注射,n=30)和乙酰谷酰胺治疗组(n=28),1周治疗后观察临床疗效。结果综合治疗组显效21例(70.0%),有效9例(30.0%),无效0例,无死亡,总有效率100%;而乙酰谷酰胺治疗组显效8例(28.6%),有效8例(28.6%),无效7例(25.0%),死亡5例(17.8%),总有效率为57.1%,2组总有效率比较差异有统计学意义(P<0.001)。综合治疗组死亡率和血氨浓度也显著降低(P<0.05)。结论综合降低血氨浓度是控制乙肝肝硬化患者肝性脑病的有效方法,可显著降低肝性脑病的发生,降低患者死亡。

Objective To study the effect of comprehensive treatment through decreasing serum ammonia on hepatic encephalopathy in patients with hepatitis B liver cirrhosis. Methods 56 patients with hepatitis B liver cirrhosis who had acute hepatic encephalopathy were randomly classified into comprehensive treatment and control groups. Patients in comprehensive treatment group （n = 30） were treated with receiving lactulose, acetic acid enema, acelglutamine injection, while control patients were treated with acelglutamine alone. The efficacy was evaluated 7 days after treatment. The serum ammonia was also determined subsequently. Results In comprehensive treatment group, 21 patients （70.0%） showed marked improvement of clinical syndromes, 9 cases （30.0%） with improvement, no case without any response, and no death reported, the total rate of effects was 100%. However, in control group, 8 patients （28.60%） demonstrated to be marked improvement, 8 patients （28.6 %） with improvement, 7 patients （25.0 %） with no response, and 5 （17.8 %） dead patients, the total rate of effects was 57.1%. There was significant difference in total rate of effects between two groups （P〈0. 001）. Importantly, the death rate and serum ammonia in comprehensive treatment group were significantly decreased than that in control（P〈0.05）. Conclusion Comprehensive treatment through decreasing serum ammonia is effective in the control of hepatic encephalopathy in patients with hepatitis B liver cirrhosis, and could decrease death.