中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
5期
382-385
,共4页
张照兰%时峰%路小燕%马素平%费景兰
張照蘭%時峰%路小燕%馬素平%費景蘭
장조란%시봉%로소연%마소평%비경란
慢加急性肝衰竭%内毒素血症%中药灌肠%血浆置换
慢加急性肝衰竭%內毒素血癥%中藥灌腸%血漿置換
만가급성간쇠갈%내독소혈증%중약관장%혈장치환
Acute-on-chronic hepatic failure%Endotoxemia%Enema with traditional Chinese medicine decoction%Plasma exchange
目的：观察肠毒清中药灌肠联合血浆置换对慢加急性肝衰竭患者内毒素血症的影响。方法采用前瞻性随机对照研究方法，选择河南中医学院第一附属医院2009年1月至2012年6月收治的68例慢加急性肝衰竭患者，按随机数字表法分为治疗组和对照组，每组34例。对照组给予保肝、退黄、降酶，乙型肝炎患者给予抗病毒联合血浆置换等西医综合治疗。治疗组在西医综合治疗基础上加用中药肠毒清（组成：人参10 g，厚朴6 g，大黄6 g，枳实6 g，赤芍10 g）灌肠，每日2次，并联合血浆置换，72 h 1次，一般治疗3～4次，两组疗程均为4周。观察治疗前后总胆红素（TBil）、丙氨酸转氨酶（ALT）、白蛋白（ALB）、凝血酶原活动度（PTA）、内毒素变化和乏力、纳差、腹胀、尿少、出血倾向、肝性脑病、感染、腹水临床症状、体征的改善情况，并观察随访24周生存率。结果两组治疗前TBil、ALT、ALB、PTA比较差异均无统计学意义（均P＞0.05），治疗后TBil、ALT均较治疗前明显降低，PTA较治疗前明显升高，且以治疗组变化更显著〔TBil（μmol/L）：89.6±52.3比124.6±64.4，ALT（U/L）：52.4±32.1比98.3±42.5，PTA：（53.8±11.5）%比（41.2±10.2）%，均P＜0.05〕；两组治疗前后ALB水平比较差异均无统计学意义（均P＞0.05）。两组早、中、晚期患者治疗后内毒素（kU/L）水平均较治疗前降低，且以治疗组降低更显著（早期：0.094±0.015比0.109±0.032，中期：0.102±0.019比0.146±0.062，晚期：0.124±0.022比0.196±0.074，均P＜0.05）。两组中、晚期24周生存率均较早期明显降低，治疗组早、中期生存率均明显高于对照组〔早期：94.1%（16/17）比83.3%（15/18），中期：85.7%（12/14）比42.9%（6/14），均P＜0.01〕。结论肠毒清中药灌肠联合血浆置换治疗慢加急性肝衰竭，能够清除胆红素、减轻内毒素血症，提高PTA，增加24周生存率。
目的：觀察腸毒清中藥灌腸聯閤血漿置換對慢加急性肝衰竭患者內毒素血癥的影響。方法採用前瞻性隨機對照研究方法，選擇河南中醫學院第一附屬醫院2009年1月至2012年6月收治的68例慢加急性肝衰竭患者，按隨機數字錶法分為治療組和對照組，每組34例。對照組給予保肝、退黃、降酶，乙型肝炎患者給予抗病毒聯閤血漿置換等西醫綜閤治療。治療組在西醫綜閤治療基礎上加用中藥腸毒清（組成：人參10 g，厚樸6 g，大黃6 g，枳實6 g，赤芍10 g）灌腸，每日2次，併聯閤血漿置換，72 h 1次，一般治療3～4次，兩組療程均為4週。觀察治療前後總膽紅素（TBil）、丙氨痠轉氨酶（ALT）、白蛋白（ALB）、凝血酶原活動度（PTA）、內毒素變化和乏力、納差、腹脹、尿少、齣血傾嚮、肝性腦病、感染、腹水臨床癥狀、體徵的改善情況，併觀察隨訪24週生存率。結果兩組治療前TBil、ALT、ALB、PTA比較差異均無統計學意義（均P＞0.05），治療後TBil、ALT均較治療前明顯降低，PTA較治療前明顯升高，且以治療組變化更顯著〔TBil（μmol/L）：89.6±52.3比124.6±64.4，ALT（U/L）：52.4±32.1比98.3±42.5，PTA：（53.8±11.5）%比（41.2±10.2）%，均P＜0.05〕；兩組治療前後ALB水平比較差異均無統計學意義（均P＞0.05）。兩組早、中、晚期患者治療後內毒素（kU/L）水平均較治療前降低，且以治療組降低更顯著（早期：0.094±0.015比0.109±0.032，中期：0.102±0.019比0.146±0.062，晚期：0.124±0.022比0.196±0.074，均P＜0.05）。兩組中、晚期24週生存率均較早期明顯降低，治療組早、中期生存率均明顯高于對照組〔早期：94.1%（16/17）比83.3%（15/18），中期：85.7%（12/14）比42.9%（6/14），均P＜0.01〕。結論腸毒清中藥灌腸聯閤血漿置換治療慢加急性肝衰竭，能夠清除膽紅素、減輕內毒素血癥，提高PTA，增加24週生存率。
목적：관찰장독청중약관장연합혈장치환대만가급성간쇠갈환자내독소혈증적영향。방법채용전첨성수궤대조연구방법，선택하남중의학원제일부속의원2009년1월지2012년6월수치적68례만가급성간쇠갈환자，안수궤수자표법분위치료조화대조조，매조34례。대조조급여보간、퇴황、강매，을형간염환자급여항병독연합혈장치환등서의종합치료。치료조재서의종합치료기출상가용중약장독청（조성：인삼10 g，후박6 g，대황6 g，지실6 g，적작10 g）관장，매일2차，병연합혈장치환，72 h 1차，일반치료3～4차，량조료정균위4주。관찰치료전후총담홍소（TBil）、병안산전안매（ALT）、백단백（ALB）、응혈매원활동도（PTA）、내독소변화화핍력、납차、복창、뇨소、출혈경향、간성뇌병、감염、복수림상증상、체정적개선정황，병관찰수방24주생존솔。결과량조치료전TBil、ALT、ALB、PTA비교차이균무통계학의의（균P＞0.05），치료후TBil、ALT균교치료전명현강저，PTA교치료전명현승고，차이치료조변화경현저〔TBil（μmol/L）：89.6±52.3비124.6±64.4，ALT（U/L）：52.4±32.1비98.3±42.5，PTA：（53.8±11.5）%비（41.2±10.2）%，균P＜0.05〕；량조치료전후ALB수평비교차이균무통계학의의（균P＞0.05）。량조조、중、만기환자치료후내독소（kU/L）수평균교치료전강저，차이치료조강저경현저（조기：0.094±0.015비0.109±0.032，중기：0.102±0.019비0.146±0.062，만기：0.124±0.022비0.196±0.074，균P＜0.05）。량조중、만기24주생존솔균교조기명현강저，치료조조、중기생존솔균명현고우대조조〔조기：94.1%（16/17）비83.3%（15/18），중기：85.7%（12/14）비42.9%（6/14），균P＜0.01〕。결론장독청중약관장연합혈장치환치료만가급성간쇠갈，능구청제담홍소、감경내독소혈증，제고PTA，증가24주생존솔。
ObjectiveTo observe the effect of enema with Chinese medicine Changduqing combined with plasma exchange for treatment of endotoxemia in patients with acute-on-chronic liver failure.Methods A prospective randomized controlled trial was conducted, and 68 patients with acute-on-chronic hepatic failure who were hospitalized from January 2009 to June 2012 in the First Affiliated Hospital of Henan University of Traditional Chinese Medicine were randomly divided into treatment and control groups, 34 cases in each group. The patients in control group were treated with plasma exchange combined with western medicine comprehensive treatment such as protecting liver, reducing enzyme, removing jaundice, and in cases with hepatitis B, antiviral therapy was added. The treatment in patients of treatment group was the same as that in the control group, but additionally Changduqing enema of TCM decoction was given(ingredients: radix et rhizoma ginseng 10 g, flos magnolia officinalis 6 g, radix et rhizoma rhei 6 g, fructus aurantii immaturus 6 g, radix paeoniae rubra 10 g),twice a day combined with 3-4 times of plasma exchange treatment, once every 72 hours. The course of treatment of both groups was 4 weeks. The changes of total bilirubin (TBil), alanine aminotransferase(ALT), albumin(ALB), prothrombin activity(PTA), endotoxin, the improvement of clinical symptoms and signs such as lacking in strength, poor appetite, abdominal distension, oliguria, bleeding tendency, hepatic encephalopathy, infection and ascites were observed before and after treatment, and the survival rate in 24 weeks of follow-up was also investigated.Results Before treatment, the comparisons of TBil,ALT, ALB and PTA between the two groups were of no statistically significant differences(allP>0.05); compared with those before treatment, the levels of TBil and ALT were obviously decreased, and PTA was markedly increased after treatment in both groups, the degree of change being more prominent in treatment group〔TBil(μmol/L): 89.6±52.3 vs. 124.6±64.4, ALT(U/L):52.4±32.1 vs. 98.3±42.5, PTA:(53.8±11.5)% vs.(41.2±10.2)%, allP<0.05〕. The ALB levelsbefore and after treatment of both groups showed no significant difference(bothP>0.05). After treatment, the endotoxin(kU/L) in both groups were decreased in inchoate, developing and fully-developed stages and the descent being more significant in treatment group(inchoate stage: 0.094±0.015 vs. 0.109±0.032, developingstage: 0.102±0.019 vs. 0.146±0.062, fully-developed stage: 0.124±0.022 vs. 0.196±0.074, allP<0.05). The 24-week survival rates of developing and fully-developed stages in patients of both groups were lower than the rate in patients of inchoate stage, and the rates of treatment group in inchoate and developing stages were remarkably higher than the rate in control group〔inchoate stage: 94.1%(16/17) vs. 83.3%(15/18), developed stage: 85.7%(12/14) vs. 42.9%(6/14),bothP<0.01〕.ConclusionEnema with TCM Changduqing combined with plasma exchange for treatment of patients with acute-on-chronic liver failure can remove bilirubin, ameliorate endotoxemia, elevate PTA level and increase the survival rate of patients in 24 weeks of follow-up.
