肠毒清灌肠联合血浆置换治疗慢加急性肝衰竭内毒素血症34例  

A study on Changduqing enema combined with plasma exchange for treatment of endotoxemia in 34 cases with acute-on-chronic hepatic failure

作　　者：张照兰[1] 时峰[2] 路小燕[3] 马素平[1] 费景兰[1] 

机构地区：[1]河南中医学院第一附属医院,河南郑州450000 [2]河南省永城市人民医院,河南永城476600 [3]天津中医药大学附属武清医院,天津301700

出　　处：《中国中西医结合急救杂志》2014年第5期382-385,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河南省科技攻关项目（0496060401）

摘　　要：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�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）：

关 键 词：慢加急性肝衰竭 内毒素血症 中药灌肠 血浆置换 

分 类 号：R512.6[医药卫生—内科学]