摘要
目的探讨门冬氨酸鸟氨酸联合纳洛酮对肝性脑病患者认知功能、预后质量及神经肽类水平的影响。方法将84例肝性脑病患者随机分入研究组和对照组，每组各42例患者。对照组患、者应用常规治疗方案治疗肝性脑病，研究组患者则在常规治疗方案的基础上加用门冬氨酸鸟氨酸联合纳洛酮进行治疗。利用长谷川智能量表和简易精神状态量表评估两组患者治疗后的认知功能改变隋况，观察两组患者的总有效率、神智清醒时间，同时测定治疗前后的肝功能指标（ALT、AST、Y谷氨酰转移酶和总胆红素）、血氨浓度以及脑脊液5种神经肽类（精氨酸加压素、催产素、β-内啡肽、生长抑素和神经降压素）的变化水平。各检测指标组间比较用t检验，治疗总有效率的比较用爿。检验。结果（1）研究组患者治疗后的总有效率为83．33％，显著高于对照组的73．81％（X2=15．926，P〈0．01）。（2）虽然两组患者在按照各自治疗方案医治后血氨浓度都出现了大幅降低（P〈0．05），但是研究组患者的血氨降低效果比对照组患者更理想（t=2．574，P=0．016）。（3）研究组和对照组患者的神智清醒时间分别为（6．45±2．72）h和（22．37±10．26）h，差异有统计学意义（t=2．516，P=0．007）。（4）虽然两组患者治疗后其肝功能指标较治疗前都出现不同程度的好转（P〈0．05），但研究组患者治疗后的ALT、Y谷氨酰转移酶和总胆红素水平还是显著低于对照组患者的治疗后水平。（5）研究组患者不论是在治疗后的长谷川智能量表还是简易精神状态量表的评分上都显著优于对照组患者。（6）两组患者的5种神经肽类物质水平在治疗后只有精氨酸加压素和β-内啡肽出现了降低，并且研究组患者治疗后的精氨酸加压素和β-内啡肽水平都显著低于对照组患者治疗后水平。结论联用门冬氨酸鸟氨酸联合纳洛酮对肝性脑病患者的治疗效果优于常规治疗方案，值得推广应用。
Objective To investigate the potential effects on cognitive function, prognosis, and neuropeptide levels of patients in response to combination therapy with ornithine aspartate plus naloxone for hepatic encephalopathy. Methods Eighty-four consecutive patients diagnosed with hepatic eneephalopathy were randomly divided into two equal groups. The control group （n = 42） received traditional medical treatment, and the research group （n = 42） received the traditional medical treatment as well as the combination therapy with omithine aspartate plus naloxone. The supplemental treatment was comprised of daily intravenous injection of 10-15 g omithine aspartate in 250 ml of 5% glucose plus intravenous drip of 3 mg naloxone in 100 ml of 5%glucose, and was given in 7-day cycles for one or two cycles. The cognitive function of patients was assessed by Hasegawa Intelligence Scale （HDS） and Mini-Mental State Examination （MMSE） questionnaires. The effective rate and time duration from coma to consciousness were recorded. Changes in blood ammonia level, markers of liver function, and neuropeptide levels were measured by standard biochemical assays. Intergroup differences were assessed by the Chi-squared test. Results The HDS and MMSE scores of the research group were significantly higher than those of the control group after therapy. The effective rate, lime duration from coma to consciousness, blood ammonia, the liver function roarkers alanine aminotransferase, gamma- glutamyl-transpeptidase and total bilirubin, and the neuropeptides arginine vasopressin and beta-endorphin were remarkably improved after treatment in the research group, as compared with that in the control group. Conclusion Supplementing the traditional treatment for hepatic encephalopathy with omithine aspartate plus naloxone combination therapy provides better therapeutic outcome than traditional treatment alone.
出处
《中华肝脏病杂志》
CAS
CSCD
北大核心
2013年第5期385-388,共4页
Chinese Journal of Hepatology
关键词
肝性脑病
纳洛酮
预后
Hepatic enccphalopathy
Naloxone
Prognosis
