微生态制剂联合肠内营养治疗肝性脑病的研究

Clinical research on microecologic treatment combined enteral nutrition for hepatic encephalopathy

目的 观察微生态制剂联合肠内营养治疗对肝性脑病患者血清内毒素、肿瘤坏死因子α（TNF-α）、白细胞介素18（IL-18）、血氨水平及全身营养状态的影响.方法 选取60例肝性脑病患者,在常规保肝利尿等治疗基础上,随机分为3组分别给予口服培菲康加肠内营养、单纯口服培菲康、单纯静脉营养治疗,疗程均为2周.分别检测治疗前后第7天、第14天血清内毒素、TNF-α、IL-18、血氨及白蛋白水平.结果 与治疗前相比,培菲康联合肠内营养治疗能明显降低血清内毒素、TNF-α、IL-18及血氨水平,明显升高血浆白蛋白,与单用培菲康和单用静脉营养治疗相比差异有统计学意义（P＜0.05）.结论 微生态制剂联合肠内营养治疗能有效清除肝性脑病患者血氨、降低内毒素血症、保护肠黏膜屏障及改善机体的营养状态,是临床治疗肝性脑病安全有效方法.

Objective To evaluate the effect of microecologic treatment combined enteral nutrition on serum endotoxin,tumor necrosis factor-α （TNF-α）,interleukin-18 （IL-18）,blood ammonia levels and nutritional status in patients with hepatic encephalopathy.Methods 60 patients with hepatic encephalopathy were allocted randomly into 3 groups,on the basis of conventional liver protective therapy and uragogue with one group given probiotics plus enteral nutrition,one given probiotics only,and the 3rd group given intravenous nutrition.The whole course of treatment was four weeks.Serum levels of endotoxin,TNF-α,IL-18,ammonia and albumin were determined before and on the 7th and 14th day after treatment.Results The levels of serum endotoxin,TNF-α,IL-18 and blood ammonia in the combined treatment group decreased remarkably after treatment,while the level of serum albumin elevated markedly.The difference was significant at statistics as compared with the only probiotics group and intravenous nutrition group （P＜0.05）.Conclusion Microecologic treatment combined enteral nutrition could effectively reduce blood ammonia and serum endotoxin levels,protect intestinal mucosal barrier,as well as improve nutritional status of patients with hepatic encephalopathy,which was considered as a safe and efficient therapy.