摘要
目的探讨双歧杆菌三联活菌胶囊联合乳果糖对经颈静脉肝内门体分流术(transjugular intrahepatic portalsystemic shunt,TIPS)术后肝性脑病的预防效果。方法选取2018年3月至2020年6月南京大学医学院附属鼓楼医院收治的177例拟行TIPS治疗的肝硬化门静脉高压患者为研究对象,采用随机数字表法将入选患者分为乳果糖组、双歧杆菌组和联合组,每组各59例,在常规治疗基础上从术后第1天开始分别给予三组患者乳果糖、双歧杆菌三联活菌胶囊、乳果糖+双歧杆菌三联活菌胶囊治疗,持续10 d,比较三组患者术后第1天(干预前)、术后第10天(干预后)的血谷丙转氨酶(alanine amin otransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、总胆红素(total bilirubin,TBIL)和血氨水平,数字连接试验(number connection test,NCT)和数字符号试验(digit symbol test,DST)结果,术后肝性脑病发生率。结果全部患者均成功完成TIPS,三组患者干预后血ALT、AST、TBIL、血氨水平均显著低于本组干预前(均P<0.05),NCT时间均显著短于本组干预前(均P<0.05),DST评分均显著高于本组干预前(均P<0.05);联合组患者干预后血ALT、AST、TBIL、血氨水平均显著低于乳果糖组和双歧杆菌组(均P<0.05),NCT时间显著短于乳果糖组和双歧杆菌组(均P<0.05),DST评分显著高于乳果糖组和双歧杆菌组(均P<0.05)。177例患者术后共出现26例肝性脑病,总发生率为14.7%,其中以0级最多见,其次是1级,无一例4级肝性脑病和死亡患者。联合组患者肝性脑病发生率显著低于乳果糖组和双歧杆菌组(均P<0.05)。结论双歧杆菌三联活菌胶囊联合乳果糖能有效预防TIPS术后肝性脑病的发生,显著降低患者血氨水平,改善肝功能与心理智能状况。
Objective To explore the prevention effect of bifidobacterium triple viable capsule combined with lactulose on hepatic encephalopathy(HE)after transjugular intrahepatic portalsystemic shunt(TIPS).Method One hundred and seventy-seven patients with liver cirrhosis and portal hypertension underwent TIPS in the Affiliated Hospital of Nanjing University Medical School,Nanjing Drum Tower Hospital from March 2018 to June 2020 were enrolled for the study,according to the random number table method,they were divided into lactulose group,bifidobacterium group and combination group,with 59 cases in each group,they were given lactulose,bifidobacterium triple viable capsule,lactulose+bifidobacterium triple viable capsule respectively from the first day after operation,which lasted for 10 days.The fasting venous blood levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),ammonia,results of number connection test(NCT),digit symbol test(DST)and the incidence of HE were compared among the three groups on the first day after operation(before intervention)and the tenth day after operation(after intervention).Result All patients successfully completed TIPS.After intervention,the levels of blood ALT,AST,TBIL and blood ammonia in the three groups were significantly lower than those before intervention(all P<0.05),the NCT time were significantly shorter than those before intervention(all P<0.05),the DST scores were significantly higher than those before intervention(all P<0.05).After intervention,the levels of blood ALT,AST,TBIL and blood ammonia in combination group were significantly lower than those in lactulose group and bifidobacterium group(all P<0.05),the NCT time was significantly shorter than that in lactulose group and bifidobacterium group(all P<0.05),and the DST score was significantly higher than that in lactulose group and bifidobacterium group(all P<0.05).A total of 26 cases of HE were observed after operation in 177 patients,with the total incidence rate of 14.7%,among which the most common was grade 0,followed by grade 1,and there was no grade 4 HE and no dead patient.The incidence of HE in combination group was significantly lower than that in lactulose group and bifidobacterium group(all P<0.05).Conclusion Bifidobacterium triple viable capsule combined with lactulose can effectively prevent the occurrence of HE after TIPS,significantly reduce the blood level of ammonia,and improve patients'liver function and mental intelligence.
作者
史俪璐
徐慧
陈慧
Shi Lilu;Xu Hui;Chen Hui(Department of Gastroenterology,the Affiliated Hospital of Nanjing University Medical School,Nanjing Drum Tower Hospital,Nanjing 210008,China)
出处
《中国医学前沿杂志（电子版）》
2021年第5期79-83,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
肝性脑病
经颈静脉肝内门体分流术
双歧杆菌三联活菌胶囊
乳果糖
氨
预防
Hepatic encephalopathy
Transjugular intrahepatic portalsystemic shunt
Bifidobacterium triple viable capsule
Lactulose
Ammonia
Prevention
