CAJ | 학술논문

目的观察门冬氨酸鸟氨酸(OA)联合乳果糖对预防和治疗改良经皮经肝穿刺改良式肝内门体静脉分流术(TiPS)后肝性脑病的临床疗效.方法选择因肝硬化门静脉高压行改良TIPS治疗的56例患者,术后均给予静脉滴注OA及口服乳果糖,观察术后肝性脑病的发生及血氨变化情况.对发生肝性脑病的患者,静脉滴注治疗剂量的OA及口服乳果糖,观察OA联合乳果糖治疗肝性脑病的效果及治疗前后血氨的变化.结果 56例患者在改良TIPS术后预防性使用OA及乳果糖情况下,均未见肝性脑病发生.停用OA及乳果糖后,有5例发生肝性脑病,发病率为8.93％(5/56).改良TIPS术后患者的血氨较术前升高[(88.2±23.0)μmol/L比(43.1±19.2)μmol/L],差异有统计学意义(P＜0.05).5例肝性脑病患者经OA联合乳果糖治疗(联合用药平均治疗时间7d)后,均治愈,5例患者应用OA联合乳果糖治疗后血氨较治疗前显著降低[(69.1±14.1)μmol/L比(139.2±15.8)μmol/L],差异有统计学意义(P＜0.05).结论 OA联合乳果糖可以预防和治疗改良TIPS后肝性脑病,其机制与降低血氨有关.
목적 관찰문동안산조안산(OA)연합유과당대예방화치료개량경피경간천자개량식간내문체정맥분류술(TiPS)후간성뇌병적림상료효.방법 선택인간경화문정맥고압행개량TIPS치료적56례환자,술후균급여정맥적주OA급구복유과당,관찰술후간성뇌병적발생급혈안변화정황.대발생간성뇌병적환자,정맥적주치료제량적OA급구복유과당,관찰OA연합유과당치료간성뇌병적효과급치료전후혈안적변화.결과 56례환자재개량TIPS술후예방성사용OA급유과당정황하,균미견간성뇌병발생.정용OA급유과당후,유5례발생간성뇌병,발병솔위8.93％(5/56).개량TIPS술후환자적혈안교술전승고[(88.2±23.0)μmol/L비(43.1±19.2)μmol/L],차이유통계학의의(P＜0.05).5례간성뇌병환자경OA연합유과당치료(연합용약평균치료시간7d)후,균치유,5례환자응용OA연합유과당치료후혈안교치료전현저강저[(69.1±14.1)μmol/L비(139.2±15.8)μmol/L],차이유통계학의의(P＜0.05).결론 OA연합유과당가이예방화치료개량TIPS후간성뇌병,기궤제여강저혈안유관.
Objective To observe the clinical effects of ornithine aspartate (OA) and lactulose on the prevention and treatment of hepatic encephalopathy for patients with portal hypertension after modified transjugular intrahepatic portosystemic shunt (TIPS).Methods Fifty-six patients with portal hypertension were treated by modified TIPS,OA and lactulose after the operation were given,the incidence of postoperative hepatic encephalopathy and the changes of blood ammonia were observed.Patients with hepatic encephalopathy after modified TIPS accepted therapeutic dosage of OA and lactulose,and the clinical effects of combined OA and lactulose on treatment of the hepatic encephalopathy after modified TIPS and changs of blood ammonia were evaluated as well.Results Prophylactic use of combined OA and lactulose after modified TIPS,there was no hepatic encephalopathy happened in 56 patients.Hepatic encephalopathy was seen in 5 patients after discontinuation of combined OA and lactulose,the incidence rate of hepatic encephalopathy was 8.93％ (5/56).The level of blood ammonia in patients after modified TIPS was significanby higher than that before treatment [(88.2 ± 23.0) μ mol/L vs.(43.1 ± 19.2) μ mol/L,P ＜ 0.05].Five patients with hepatic encephalopathy was improved quickly after given therapeutic dosage of OA and lactulose (the average treatment time was 7 d),and the level of blood ammonia was significantly lower than before treatment [(69.1 ± 14.1) p mol/L vs.(139.2 ± 15.8) μ mol/L,P＜ 0.05].Conclusion Combined OA and lactulose can effectively prevent and treat the hepatic encephalopathy after modified TIPS,its mechanism may be associated with reduction of blood ammonia level.