氨假说和细胞因子在肝性脑病发病中的研究进展

Effect of colon dialysis combined with Chinese medicine enema on hepatic encephalopathy in patients with liver cancer and cirrhosis

AIM: To investigate the effect of colon dialysis in combination with Chinese medicine enema on hepatic encephalopathy in patients with primary hepatic carcinoma and cirrhosis and summarize nursing experience.

METHODS: Sixty patients with primary hepatic carcinoma and cirrhosis were randomly divided into a study group and a control group. Each group contained 30 patients. The control group was treated by comprehensive treatment, while the study group was treated with comprehensive treatment and colon dialysis in combination with Chinese medicine enema.

RESULTS: The total effective rate in the study group was significantly higher than that in the control group (86.7% vs 60.0%, P < 0.05). The improvement of liver function, the decrease of plasma ammonia, the time to weak up and digital time (NCT) in the treatment group were better than those in the control group.

CONCLUSION: Colon dialysis in combination with Chinese medicine enema and scientific nursing can significantly reduce the level of plasma ammonia, improve the liver function, shorten the time to wake up, and improve the total effective rate in hepatocellular carcinoma patients with liver cirrhosis and hepatic encephalopathy.

Advances in diagnosis and treatment of minimal hepatic encephalopathy

Minimal hepatic encephalopathy (MHE), also known as subclinical hepatic encephalopathy (SHE), is a common complex and potentially reversible neuropsychiatric syndrome secondary to chronic liver disease or cirrhosis. Although a clear pathogenesis is yet to be determined, elevated ammonia in serum and the central nervous system is the mainstay for pathogenesis and treatment of MHE. Patients with MHE, regardless of its cause, show a number of quantifiable neuropsychological defects, yet have a normal mental and neurological status on global clinical examination. Although ammonia is the main toxic substance involved in the pathogenesis of hepatic encephalopathy, other mechanisms, such as modifications of the blood-brain barrier, disruptions in neurotransmission and abnormalities in GABAergic and benzodiazepine pathways, may also play a role. Current treatments are based on reducing intestinal ammonia load by agents such as antibiotics, disaccharides and probiotics whose efficacy is yet to be clearly established. This paper summarizes the latest advances in the diagnosis and treatment of MHE.