中西医结合治疗肝硬化肝性脑病的临床研究

Clinical Effects of the Naloxone Combined with Herbal Enema on Patients with Hepatic Encephalopathy

目的探讨纳洛酮联合中药灌肠剂保留灌肠治疗肝性脑病的临床疗效。方法将76例临床诊断为肝性脑病的患者随机分成纳洛酮联合中药灌肠剂组(治疗组,n=38)和纳洛酮组(对照组,n=38),治疗组给予纳洛酮1.2 g加入5%葡萄糖溶液250 ml静脉滴注,2次/d,持续用药5 d;中药灌肠剂保留灌肠:取生大黄30 g,水煎取汁100 ml,加人30%白醋20 ml,保留灌肠30 min,2次/d,持续用药5 d。对照组给予纳洛酮1.2 g加入5%葡萄糖溶液250 ml静脉滴注,2次/d,疗程均为5d。两组分别于治疗前、治疗7d后观察临床症状、血浆β-内啡呔(βendorphin,β-EP)及血氨变化情况。结果治疗5 d后,治疗组治愈率、显效率和总有效率均明显高于对照组(P<0.05);两组血氨较治疗前均明显下降(P<0.05),治疗后两组血氨及治疗前、后血氨浓度降低值差异均有统计学意义(P<0.05,P<0.01);治疗后两组血浆β-EP水平明显降低,组间比较,差异有统计学意义(P<0.05);两组均未见明显不良反应。结论纳洛酮联合中药灌肠剂治疗肝性脑病比单用纳洛酮具有更好的疗效。

Objective To observe the clinical effects of naloxone combined with traditional Chinese medicine Jiang＇an mixture on patients with hepatic encephalopathy. Methods Seventy-six patients with hepatic encephalopathy were randomly divided into treatment group （n = 38） and control group （n = 38）.The treatment group were administered with naloxone 1.2g mixed with 5% glucose 250ml, intravenous drip, per 12 hour and Jiang＇an mixture herbal retention enema containing rhubarb juice 100ml and 30% white vinegar 20ml, twice per day; the control group were administered with naloxone of the same dose only.The course of the treatment lasted 5 days in total.Clinical symptoms, the changes of the blood ammonia level and β endorphin （β-EP） level of all the cases were observed before and after treatment.Results After 5-day treatment, the recovery rate, excellence rate and total effective rate of the treatment group were all signifi- cantly higher than those of the control group （P〈0.05）. The blood ammonia levels after treatment decreased significantly in both groups （P〈0.05）. Meanwhile, the blood ammonia level as well as the degree of the decrease of the blood ammo- nia before and after the treatment were significantly different in two groups （P〈0.05 and 0;01 respectively）. Regarding the treatment group, the blood β-EP level was significantly lowered compared with that of the control group.No obvious side effects were observed in both groups.Conclusion Naloxone combining with Jiang＇an Mixture is much more effective in treating hepatic encephalopathy than naloxone alone and should widely applied.