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【摘要】目的为研究门冬氨酸鸟氨酸联合乳果糖治疗肝炎后肝硬化所致肝性脑病的治疗效果。方法选取肝炎后肝硬化所致肝性脑病58例，将其分为观察组和对照组，观察组给予门冬氨酸鸟氨酸、乳果糖治疗，对照组给予谷氨酸钾、谷氨酸钠治疗，观察肝性脑病的改善及肝功、血氨的改变。结果观察组总有效率为84�38%(17/32),对照组总有效率为57�69%(15/26)，观察组疗效优于对照组(χ2=5�113，P=0�024)。观察组：治疗前后AST、ALT、TBIL、血氨含量比较，t值依次为3�823、3�432、3�649、6�435，P0�05。结论门冬氨酸鸟氨酸联合乳果糖治疗肝炎后肝硬化所致肝性脑病效果好。
【关键词】门冬氨酸鸟氨酸；乳果糖；肝性脑病
The effect of L�ornithine�L�aspartate combined with lactulose in the treatment of patients with hepatic encephalopathy after hepatic cirrhosisLIU Xiu�qin, LI Qian�qian, CAO Cun�mei� Department of Gastroenterology, Yantai Harbor Hospital, Yantai 264002,China
【Abstract】Objective To explore the effect of L�ornithine�L�aspartate combined with lactulose in the treatment of patients with hepatic encephalopathy after hepatic cirrhosis� MethodsFifty�eight patients with hepatic encephalopathy after hepatic cirrhosis from April 2006 to August 2009 were selected� They were were divided into observation group (n=32) and control group (n=26)� The observation group received treatment of L�ornithine�L�aspartate combined with lactulose� The control group received sodium glutamate injection and potassium glutamate injection,and the improvement of hepatic encephalopathy and the changes of liver function, blood ammonia before and after treatment were observed� ResultsThe total effective rate of observation group and control group were 84�38%(17/32)and 57�69%(15/26) respectively,The differences of effect between observation group and control group were statistically significant(χ2=5�113，P=0�024).The t values of AST,ALT,TBIL,Blood Ammonia of observation group before and after treatment were 3�823,3�432,3�649,6�435,and the P values were all ＜0�05�The t values of AST,ALT,Blood Ammonia between observation group and control group after treatment were 3�382,3�153,3�595, and the P values were all ＜0�05�The t value of ALT were 1�891, and the P value was above 0�05�ConclusionThe effect of observation group is better than that of the control group.
【Key words】L�ornithine�L�aspartate; Lactulose; HE(hepatic encephalopathy)
作者单位：264002烟台海港医院消化内科肝性脑病(hepatic encephalopathy，HE)是以严重肝脏疾病引起的，以代谢紊乱为基础的中枢神经系统功能失调综合征。及时合理的治疗对肝性脑病的预后尤为重要［1］。为研究门冬氨酸鸟氨酸联合乳果糖治疗肝炎后肝硬化所致的肝性脑病的治疗效果，2006年4月至2009年8月对就诊于我院的58例肝性脑病患者在常规综合治疗的基础上应用门冬氨酸鸟氨酸联合乳果糖治疗并取得良好疗效，现报告如下。
1资料与方法
1�1一般资料选择2006年4月至2009年8月就诊于我院的符合入选条件的肝炎后肝硬化所致肝性脑病58例，根据入院顺序及患者及家属意愿分为观察组和对照组。观察组32例，男20例，女12例，年龄32～75岁，病因：慢性乙型肝炎所致肝炎后肝硬化26例，丙型肝炎所致肝炎后肝硬化6例；肝性脑病分期：Ⅰ期12例,Ⅱ期10例,Ⅲ期7例,Ⅳ期3例。对照组26例，男17例，女9例，年龄35～73岁，病因：慢性乙型肝炎所致肝炎后肝硬化22例，丙型肝炎所致肝炎后肝硬化4例；肝性脑病分期：Ⅰ期11例,Ⅱ期8例,Ⅲ期5例,Ⅳ期2例。两组间性别、年龄、病因、分期等均差异无统计学意义(P>0�05)。
1�2入选标准诊断标准：①慢性肝炎后肝硬化肝性脑病患者，肝昏迷分级Ⅰ～Ⅳ。②肝功能总胆红素(TBIL)及谷丙转氨酶(ALT)均高于正常值上限 2 倍以上。③影像学显示肝硬化。排除标准：①近期服用镇静剂,酒精中毒者。②糖尿病,肾功能不全,严重的心肺疾病,心理、精神疾病。
1�3方法所有患者均常规给予去除诱因、限制蛋白摄入、维持电解质紊乱、补充白蛋白及支链氨基酸等治疗。观察组在常规治疗的基础上给予门冬氨酸鸟氨酸+5%葡萄糖注射液250 ml静脉点滴 1次/d，乳果糖口服溶液 10 ml 3次/d。对照组在常规治疗的基础上给予谷氨酸钾20 ml+谷氨酸钠20 ml+5%葡萄糖注射液250 ml静脉点滴 1次/d。7 d为1个疗程，治疗前后均检查肝功、血氨。
1�4观察指标①观察治疗前后肝功、血氨变化。②观察患者的意识障碍程度，神经系统表现及脑电图改变。
1�5疗效评价标准①显效:意识清醒,一般情况好转。②有效:肝性脑病分级改善1个级别而未完全清醒者。③无效:意识障碍无改善。总有效率=(显效例数+有效例数)/总观察例数×100%。
1�6统计学方法应用SPSS 13�0统计软件分析,计量资料用(均数±标准差)表示,采用t检验,计数资料用χ2检验。P
