冰帽参与治愈显著肝性脑病后患者认知功能的评价

Assessment of cognitive function of patients after resolution of overt hepatic encephalopathy with ice cap participated treatment

目的:评估冰帽参与治愈显著肝性脑病后对患者认知功能的影响.方法:90例C型显著肝性脑病(依据West Haven标准分级为4级)患者,随机分为3组接受如下治疗,对照组(30例):常规治疗+乳果糖灌肠;试验1组(30例):常规治疗+冰帽;试验2组(30例):常规治疗+冰帽+乳果糖灌肠,经治疗,87例患者神志恢复正常(简易智能量表评分大于25分为诊断标准),并在神志恢复正常后1 wk,进入本研究(其中对照组28例;试验1组29例;试验2组30例)进行心理智能评估:数字连接试验A、数字连接试验B、抑制控制试验.结果:数字连接试验A评估中,与对照组(46.61s±10.55 s)比较,试验1、2组完成数字连接试验A所需时间均有缩短(42.00 s±7.91 s、39.20 s±9.95 s),但仅试验2组与对照组的差异有统计学意义(P=0.004<0.05).数字连接试验B评估中,与对照组(120.68 s±28.68 s)比较,试验1、2组完成数字连接试验B所需时间均有缩短(114.48 s±27.05 s、100.30 s±31.32s),但仅试验2组与对照的差异有统计学意义(P=0.009<0.05).抑制控制试验6轮整体评估中,与对照组(11.18次±4.39次)比较,试验1、2组诱饵应答次数均有减少(9.45次±3.95次、7.43次±4.02次),但仅试验2组与对照组的差异有统计学意义(P=0.001<0.05).而试验1、2组与对照组相比,靶标应答正确率均有提高(92.34%±4.90%、93.24%±3.31%、95.20%±3.52%),但仅试验2组与对照组的差异有统计学意义(P=0.007<0.05).第4-6轮诱饵应答次数较第1-3轮减少提示学习能力的改善,在本次研究中,3组患者第4-6轮的诱饵应答次数均较第1-3轮少,但P≥0.05,差异无统计学意义.结论:冰帽可有助于改善显著性肝性脑病患者意识恢复后的认知功能缺损.

AIM： To assess the cognitive function of patients after resolution of overt hepatic encephalopathy with ice cap participated treatment. METHODS： Ninety patients diagnosed with grade 4 type C overt hepatic encephalopathy were randomly divided into 3 groups, a control group （n = 30） undergoing conventional treatment ± lactulose enema, a trial group （n = 30） undergoing conventional treatment ± ice cap, and another trial group （n = 30） Undergoing conventional treatment ± ice cap ± lactulose enema. After the above treatments, 87 patients were back to consciousness, and one week later, these patients （including 28 patients in the control group, 29 patients in the first trial group, and 30 patients in the another trial group） were evaluated for cognitive function by the number connection test-A （NCT-A）, number connection test-B （NCT-B）, and inhibitory control test （ICT）. RESULTS： The times needed for both NCT-A and NCT-B were shortened in the two trial groups compared with the control group （NCT-A： 42.00 s ± 7.91 s, 39.20 s ± 9.95 s vs 46.61 s ± 10.55 s; NCT-B： 114.48 s ± 27.05 s, 100.30 s ± 31.32 s vs 120.68 s ± 28.68 s）, but a significant difference was observed only between the second trial group and control group （P = 0.004, 0.009）. In the inhibitory control test, after 6 similar 2-min runs, the lures were reduced in both trial groups compared with the control group （9.45 ± 3.95, 7.43 ± 4.02 vs 11.18 ± 4.39）, but a significant difference was observed only between the second trial group and control group （P = 0.001）. The correct target response rate was higher in both trial groups than in the control group （92.34% ± 4.90%, 93.24% ± 3.31% vs 95.20% ± 3.52%）, and a significant difference was observed only between the second trial group and control group （P = 0.007）. The reduction for lure response may serve as a measure of learning improvement. In this study, the lure responses during runs 4-6 in the three groups were all less than those during runs 1-3, although the reduction was not statistically significant （P ≥ 0.05）. CONCLUSION： Ice cap can help to treat cognitive impairment in patients with overt hepatic encephalopathy whose consciousness had been recovered.