微生态制剂联合肠内营养治疗肝性脑病的临床研究  

Clinical research of microecologic treatment combined enteral nutrition for hepatic encephalopathy

作　　者：杨育林[1] 沈雁[1] 杨法根 

机构地区：[1]浙江中医药大学附属第二医院肝科,浙江杭州310005 [2]浙江医圣堂中医药研究所,浙江杭州310005

出　　处：《中国中西医结合消化杂志》2014年第4期173-177,共5页Chinese Journal of Integrated Traditional and Western Medicine on Digestion

基　　金：浙江省医药卫生一般研究计划(No:2012KYA136)

摘　　要：[目的]观察微生态制剂联合肠内营养治疗对肝性脑病患者血清内毒素、肿瘤坏死因子α(TNF-α)、白细胞介素18(IL-18)、血氨水平及全身营养状态的影响。[方法]选取60例肝性脑病患者,随机分为3组,在常规保肝利尿等基础上,3组分别予口服培菲康加肠内营养、单纯口服培菲康、单纯静脉营养,疗程均为2周。分别检测治疗前和治疗后第7天、第14天血清内毒素、TNF-α、IL-18、血氨及白蛋白的水平。[结果]与治疗前相比,培菲康联合肠内营养治疗能明显下调血清内毒素、TNF-α、IL-18及血氨的水平,明显升高血浆白蛋白的水平,与单用培菲康及单用静脉营养治疗相比差异有统计学意义(P<0.05)。[结论]微生态制剂联合肠内营养治疗能有效清除血氨、降低内毒素血症、保护肠黏膜屏障及改善机体的营养状态,是临床治疗肝性脑病的一条安全而高效的途径。[Objective]To evaluate the effect of microecologic treatment combined with enteral nutrition on serum endotoxin,TNF-α, IL-18, blood ammonia levels and nutritional status in patients with hepatic en- cephalopathy. [,Methods]Sixty patients with hepatic encephalopathy were allocated randomly into 3 groups. On the basis of conventional liver protective therapy and uragogue, one group was given probiotics plus en- teral nutrition,one group was given probiotics only, and another group was given intravenous nutrition. The course of treatment was four weeks. Serum levels of endotoxin, TNF-α, IL-18, ammonia and albumin were determined before and on the 7th and 14th day after treatment. [Results]The levels of serum endotox- in,TNF-α, IL-18 and blood ammonia in the combined treatment group were decreased remarkably after treatment, while the level of serum albumin was elevated markedly, and the difference was significant as compared with the other two groups（P〈0. 05）. [Conclusion]Microecologic treatment combined with enter- al nutrition can effectively reduce blood ammonia and serum endotoxin levels, protect intestinal mucosal barrier, as well as improve nutritional status of patients with hepatic encephalopathy,which is considered as a safe and efficient therapy.

关 键 词：肝性脑病 微生态制剂 肠内营养 肠黏膜屏障 内毒素血症 肿瘤坏死因子α 白细胞介素18 血氨 

分 类 号：R747.9[医药卫生—神经病学与精神病学]