CAJ | 학술논문

目的：观察乳果糖联合白醋灌肠预防消化道出血后肝性脑病的疗效及其对神经功能的影响。方法将2011年1月至2013年12月上海市浦东医院收治的90例肝硬化合并消化道出血患者依据随机数字表法分为观察组和对照组,每组45例。对照组予以乳果糖治疗,口服乳果糖15~30 mL,每日2~3次,1周为1个疗程；观察组在对照组的基础上予以白醋灌肠,白醋100 mL+生理盐水200 mL,每日1次,3 d为1个疗程。观察两组患者临床疗效及治疗前后画线试验时间、丙氨酸转氨酶( ALT)、血氨、前白蛋白( PA)、数字连接试验( NCT)、数字符号试验( DST)水平的变化。结果观察组肝性脑病发生率为11．1%,显著低于对照组的33．3%,差异有统计学意义(χ2=5．207,P<0．05)。治疗后,两组患者画线试验时间、血氨、ALT和NCT均较治疗前明显降低(P<0．01),治疗后观察组上述指标均低于对照组(均P<0．01)；而治疗后的PA和DST水平较治疗前显著提高( P<0．01),且治疗后观察组上述指标高于对照组(P<0．01)。结论乳果糖联合白醋灌肠预防消化道出血后肝性脑病疗效确切,其机制可能与降低血氨和改善肝功能具有明显的联系。
목적：관찰유과당연합백작관장예방소화도출혈후간성뇌병적료효급기대신경공능적영향。방법장2011년1월지2013년12월상해시포동의원수치적90례간경화합병소화도출혈환자의거수궤수자표법분위관찰조화대조조,매조45례。대조조여이유과당치료,구복유과당15~30 mL,매일2~3차,1주위1개료정；관찰조재대조조적기출상여이백작관장,백작100 mL+생리염수200 mL,매일1차,3 d위1개료정。관찰량조환자림상료효급치료전후화선시험시간、병안산전안매( ALT)、혈안、전백단백( PA)、수자련접시험( NCT)、수자부호시험( DST)수평적변화。결과관찰조간성뇌병발생솔위11．1%,현저저우대조조적33．3%,차이유통계학의의(χ2=5．207,P<0．05)。치료후,량조환자화선시험시간、혈안、ALT화NCT균교치료전명현강저(P<0．01),치료후관찰조상술지표균저우대조조(균P<0．01)；이치료후적PA화DST수평교치료전현저제고( P<0．01),차치료후관찰조상술지표고우대조조(P<0．01)。결론유과당연합백작관장예방소화도출혈후간성뇌병료효학절,기궤제가능여강저혈안화개선간공능구유명현적련계。
Objective To observe the efficacy of lactulose combined with vinegar enema in prevention of hepatic encephalopathy after gastrointestinal bleeding, and their impact on the nerve function. Methods Totalof 90 patients with cirrhosis combined with gastrointestinal bleeding admitted to Shanghai Pudong Hospi-tal from Jan. 2011 to Dec. 2013 were divided into observation group and control group according to the ran-dom number method,45 cases in each group. The control group received lactulose( oral lactulose 15-30 mL, 2 times or 3 times daily,a week for a course);the observation group was given white vinegar enema ( white vinegar 100 mL+saline 200 mL,1 time a day,3 days for a course) on the basis of the control group′s treat-ment. Efficacy after treatment,the levels of plate streaking test time,prealbumin(PA),alanine aminotrans-ferase(ALT),ammonia,number connection test(NCT) and digit symbol test(DST) before and after treat-ment were observed in each group. Results The incidence of hepatic encephalopathy was 11. 1% in the observation group,significantly lower than 33. 3% in the control group (χ2 =5. 207,P<0. 05). After treat-ment,plate streaking test time,ammonia,ALT and NCT were significantly lower than those before treatment (P<0. 01),the levels in the observation group were lower significantly than the control group(P<0. 01);the levels of PA and DST were significantly increased after treatment than before treatment(P<0. 01),the levels increased more in the observation group than the control group(P<0. 01). Conclusion The efficacy of lactulose combined with white vinegar enema in prevention of hepatic encephalopathy after gastrointestinal bleeding is obvious, and its mechanisms may be associated with decreasing blood ammonia and improving liver function.