乳果糖溶液在改善肝癌患者动脉栓塞治疗后腹部和肝性脑病症状中的作用

Effect of lactulose on alleviating abdominal symptoms and encephalopathy after transcatheter arterial chemoembolization in hepatocellular carcinoma

目的:探讨TACE后使用乳果糖溶液在改善患者腹部症状以及肝性脑病的作用. 方法:100例原发性肝癌患者随机分组行经导管肝动脉化疗栓塞术,A组(n=50)术后给予杜秘克乳果糖溶液15-30 mL, 3次/d,B组(n=50)不服用乳果糖.治疗后分别观察患者每日大便次数、腹胀、呕吐情况、TACE前后肝肾功能(包括TBIL,ALT,ALB,BUN)和血氨的变化情况以及两组出现肝性脑病的情况. 结果:A、B两组平均大便次数分别为1.86±0.83次/d和0.48±0.41次/d,差异有显著性意义(U=309.00,P<0.0001). 腹胀和呕吐方面,A组显著好于B组(X2=7.860,P=0.02). 虽然两组治疗前后TBIL,ALT,ALB,BUN均没有显著差异(t均<1.660,P>0.05),但是A组血氨显著低于B 组(t=3.091,P=0.003).B组肝性脑病发生率显著高于A 组(X2=6.947,P=0.038). 结论:肝癌TACE术后服用乳果糖可以促进肠道功能,改善腹胀和呕吐情况.同时可以预防肝性脑病的发生.

AIM: To investigate the effect of lactulose on alleviating abdominal symptoms and encephalopathy after transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC). METHODS: One hundred patients with HCC who were treated with TACE were divided into two groups. Patients in group A received oral lactulose (15-30 ml, 3 times/d) after TACE. No lactulose was prescripted in group B. The times of bowel movement per day, the degree of abdominal distension and vomiting in the two groups were compared. The changes of liver and renal function were evaluated with total bilirubin levels (TBIL), albumin (ALB), alanine aminotransferase (ALT) and blood urea nitrogen (BUN) before and after TACE. The prevalence of encephalopathy and blood ammonia levels in the two groups was also compared. RESULTS: The mean times of bowel movement per day in the two groups were 1.86±0.83 and 0.48±0.41, respectively, with a statistical difference (U=309.00,P<0.0001). The degree of abdominal distension and vomiting was minimal in group A than that in group B (X2 =7.860,P=0.02). Although there was no significantly difference in serum TBIL, ALB, ALT, and BUN between the two groups, the blood ammonia levels in group A were significantly lower than that in group B (t =3.091, P =0.003). The prevalence of encephalopathy in group B was higher than that in group A (X2 =6.947, P =0.038). CONCLUSION: Oral lactulose exerts prokinetic effect on gastrointestinal tract. It can relieve the symptoms of abdominal distension and vomiting after TACE and help prevent the happening of encephalopathy.