安宫牛黄丸联合醒脑静注射液治疗肝性脑病临床观察

Clinical Observation on Treatment of Hepatic Encephalopathy with Angong Niuhuang Pill and Xingnaojing Injection

目的探讨安宫牛黄丸联合醒脑静注射液治疗肝性脑病的临床效果。方法选择2015年9月-2018年5月进行治疗的肝性脑病的患者106例,依据随机数字表法分为两组,对照组53例和观察组53例。全部患者入院后给予常规治疗,对照组给予醒脑静注射液,观察组在对照组治疗方案基础上使用安宫牛黄丸。对两组治疗前后的血氨,谷丙转氨酶(ALT),总胆红素(TBil)浓度进行对比。对两组的苏醒时间,苏醒后的简易智力状态检查量表(MMSE)和改良长谷川痴呆量表(HDS-R)评分进行对比。对两组的治疗效果进行对比。对两组的不良反应情况进行比较。结果经过治疗后,对照组的血氨从(118.63±37.56)μmol/L降低到(81.65±20.51)μmol/L,ALT从(195.93±37.71)U/L降低到(89.97±19.81)U/L,TBil从(124.35±35.55)μmol/L降低到(90.28±22.34)μmol/L,观察组的血氨从(117.98±38.07)μmol/L降低到(68.04±14.51)μmol/L,ALT从(198.91±38.05)U/L降低到(67.03±13.58)U/L,TBil从(125.97±34.71)μmol/L降低到(57.06±17.65)μmol/L,观察组的变化幅度大于对照组,数据差异均具有统计学意义(t=3.944,6.953,8.494,P<0.05),对照组的苏醒时间长于观察组[(20.28±3.67)h VS.(16.95±3.09)h],对照组的MMSE评分[(16.81±4.49)分VS.(23.51±5.03)分]和HDS-R评分[(18.13±4.04)分VS.(25.32±3.57)分]低于观察组,数据差异均具有统计学意义(t=5.053,-7.234,-9.709,P<0.05),观察组治疗效果优于对照组,数据差异具有统计学意义(z=-4.760,P<0.05),在治疗过程中两组均未出现明显的不良反应。结论使用安宫牛黄丸联合醒脑静注射液治疗肝性脑病患者,可以改善患者血氨和肝功能指标,提升治疗效果,缩短苏醒时间,提升认知功能,安全性良好。

Objective To explore the clinical effect of Angong Niuhuang Pill combined with Xingnaojing Injection in the treatment of hepatic encephalopathy.Methods A total of 106 patients with hepatic encephalopathy who were treated in Children’s Hospital of Nanjing Medical University between September 2015 and May 2018.According to the method of random number,the two groups were divided into control group 53 cases and observation group 53 cases.All patients were given routine treatment after admission.The control group was given Xingnaojing Injection and the observation group was treated with Angong Niuhuang Pill on the basis of the treatment plan of the control group.Blood ammonia,alanine aminotransferase(ALT)and total bilirubin(TBil)concentrations were compared between the two groups before and after treatment.The wake-up time,the Simple Mental State Examination Scale(MMSE)after awakening and the modified Hasegawa Dementia Scale(HDS-R)score of the two groups were compared.The treatment effects of the two groups were compared.We compared adverse reactions between the two groups.Results After treatment,the blood ammonia of the control group decreased from(118.63±37.56)μmol/L to(81.65±20.51)μmol/L,and ALT decreased from(195.93±37.71)U/L to(89.97±19.81)U/L.TBil decreased from(124.35±35.55)μmol/L to(90.28±22.34)μmol/L.The blood ammonia of the observation group decreased from(117.98±38.07)μmol/L to(68.04±14.51)μmol/L,and ALT decreased from(198.91±38.05)U/L to(67.03±13.58)U/L,TBil reduced from(125.97±34.71)μmol/L was to(57.06±17.65)μmol/L.The change of the observation group was larger than that of the control group,and the data was statistically significant(t=3.944,6.953,8.494,P<0.05).The recovery time of the control group was longer than that of the observation group[(20.28±3.67)h VS.(16.95±3.09)h].The MMSE scores of the control group[(16.81±4.49)points VS.(23.51±5.03)points]and HDS-R scores[(18.13±4.04)points VS.(25.32±3.57)points]were lower than those of the observation group,and the data was all different(t=5.053,-7.334,-9.707,P<0.05).The therapeutic effect of the observation group was better than that of the control group,and the data was statistically significant(z=-4.760,P<0.05).No significant adverse reactions occurred in either group during the course of treatment.Conclusion Using Angong Niuhuang Pill combined with Xingnaojing Injection to treat patients with hepatic encephalopathy can improve blood ammonia and liver function indexes,improve treatment effect,shorten wake-up time,improve cognitive function and has good safety.