中药直肠滴入联合乳果糖治疗热扰心神型肝性脑病的临床疗效及对血清内毒素、血氨和肠黏膜屏障功能的影响  

Clinical efficacy of Chinese medicine enema-drip combined with lactulose in the treatment of hepatic encephalopathy with heat disturbance and its effect on serum endotoxin,blood ammonia and intestinal mucosal barrier function

作　　者：温井奎[1] 赵亚男 王守云[1] 周晓丹 焦秀娟[1] 曹立华[1] 赵培利[1] 刘加群[1] 齐丽韫[1] 刘坤[1] 赵志军[1] 赵晶 WEN Jingkui;ZHAO Yanan;WANG Shouyun;ZHOU Xiaodan;JIAO Xiujuan;CAO Lihua;ZHAO Peili;LIU Jiaqun;QI Liyun;LIU Kun;ZHAO Zhijun;ZHAO Jing(Department of Chinese and Western Medicine and Liver Diseases,The Third Hospital of Qinhuangdao,Qinhuangdao,Hebei 066000,China)

机构地区：[1]秦皇岛市第三医院中西医肝病科,河北秦皇岛066000

出　　处：《安徽医药》2024年第7期1461-1467,共7页Anhui Medical and Pharmaceutical Journal

基　　金：秦皇岛市市级科技局项目(201902A164)。

摘　　要：目的中药直肠滴入联合乳果糖治疗热扰心神型肝性脑病(HE)的临床疗效及对血清内毒素、血氨和肠黏膜屏障功能的影响。方法选取2021年4月至2022年3月秦皇岛市第三医院收治的126例HE病人按随机数字表法分为乳果糖组、中药直肠滴入组和乳果糖联合中药直肠滴入组(联合组),每组各42例,均给予常规支持治疗后,乳果糖组采用单一乳果糖治疗,中药直肠滴入组采用单一中药直肠滴入治疗(大黄、黄连、黄芩各20g,加水800mL煎至150mL),联合组采用乳果糖联合中药直肠滴入治疗,均治疗1周,观察三组病人治疗前后血清内毒素水平、血氨水平、肝功能指标[天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、总胆红素(TBil)]水平、炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)]水平、肠黏膜屏障功能[二胺氧化酶(DAO)、D-乳酸(D-LA)]水平和中医症状评分等变化情况,并评估三组病人精神状态改善时间、临床疗效和不良反应。结果三组病人精神状态改善时间联合组(5.84±0.87)d<中药直肠滴入组(6.15±1.05)d<乳果糖组(8.24±1.21)d(P<0.001);三组病人临床治疗总有效率比较联合组95.24%>中药直肠滴入组92.86%>乳果糖组73.81%(P=0.005);治疗后,三组病人血清内毒素、血氨水平、TNF-α、IL-6、DAO、D-LA、AST、ALT、TBil水平水平,面赤、谵语、惊悸、失眠多梦、口干咽燥、心烦易怒等中医症状评分比较差异有统计学意义(均P<0.001)。结论三黄汤保留灌肠联合乳果糖治疗HE型肝性脑病疗效确切,可有效调节肠道内毒素,降低血氨水平,修复肠黏膜屏障,缩短神志恢复时间,改善肝功能,降低中医症状评分,且安全性高。Objective To explore the clinical efficacy of Chinese medicine enema-drip combined with lactulose in the treatment of hepatic encephalopathy(HE)with heat disturbance and its effect on serum endotoxin,blood ammonia and intestinal mucosal barrier function.Methods A total of 126 HE patients treated in The Third Hospital of Qinhuangdao from April 2021 to March 2022 were randomly assigned into three groups:lactulose group,traditional Chinese medicine enema-drip group,and lactulose combined with traditional Chinese medicine enema-drip group(combination group),with 42 cases in each group.After receiving routine supportive treatment,the lactulose group received lactulose treatment alone,the traditional Chinese medicine enema-drip group received traditional Chinese medicine enema-drip treatment alone(Rhubarb,Coptis chinensis,Scutellaria baicalensis 20 g each,added with 800 mL of water and frying to 150 mL),and the combination group received a combination of lactulose and traditional Chinese medicine enema-drip treatment.All groups were treated for 1 week.The study observed the changes in the levels of serum endotoxin,blood ammonia,liver function indicators[aspartate transaminase(AST),alanine aminotransferase(ALT),total bilirubin(TBil)],inflammatory factors[Tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],intestinal mucosal barrier function[diamine oxidase(DAO),D-lactic acid(D-LA)],and traditional Chinese medicine symptom scores before and after treatment in the three groups.The study also evaluated the improvement time of mental status,clinical efficacy,and adverse reactions in the three groups.Results There was a significant difference in the improvement time of mental status among the three groups(P<0.001),in which the combined group(5.84±0.87)d<Chinese medicine enema-drip group(6.15±1.05)d<lactulose group(8.24±1.21)d;there was a significant difference in the total effective rate of clinical treatment among the three groups(P=0.005),of which 95.24%in the combined group>92.86%in the herbal enema-drip group>73.81%

关 键 词：肝性脑病 热扰心神 乳果糖 中药直肠滴入 三黄汤 

分 类 号：R575[医药卫生—消化系统] R747.9[医药卫生—内科学]