内科

目的探讨大黄乌梅煎剂灌肠联合培菲康口服对肝硬化并发肝性脑病患者肝肾功能及血氨、血浆内毒素水平的影响。方法选取我院收治的肝硬化并发肝性脑病患者80例为研究对象，随机分成观察组与对照组，每组40例。两组患者均给予常规治疗，对照组患者在此基础上加服培菲康治疗，观察组患者在对照组治疗的基础上使用大黄乌梅煎剂灌肠治疗，比较两组患者的临床疗效、苏醒时间、认知能力、肝功能、血氨（NH3）、血浆内毒素水平以及不良反应发生情况。结果治疗2周后，对照组和观察组患者的治疗总有效率分别为75.00%和95.00%，观察组患者的临床疗效优于对照组，差异有统计学意义（P＜0.05）。治疗后观察者患者的苏醒时间显著短于对照组（P＜0.01）。治疗2周后，观察组患者的MMSE评分、HDS-R评分显著高于对照组（P＜0.01）；TBIL、ALT、AST、PT水平显著低于对照组（P＜0.05）；两组患者的血氨、血浆内毒素水平均显著降低，与治疗前比较差异有统计学意义（P＜0.05），观察组患者的血氨、血浆内毒素水平显著低于对照组（P＜0.05）。治疗过程中两组患者均未出现明显的不良反应。结论大黄乌梅煎剂灌肠联合培菲康口服治疗肝硬化并发肝性脑病患者临床疗效显著，能有效改善患者的肝功能，减轻意识障碍，降低血氨、血浆内毒素水平，治疗安全性较高。

ObjectiveTo investigate Rhubarb ebony decoction enema combined with Bifico oral administration in patients with liver cirrhosis complicated with hepatic encephalopathy which have changes of Liver and kidney function, blood ammonia and plasma endotoxin level. Methods80 cases of liver cirrhosis complicated with hepatic encephalopathy were selected and divided into observation group and control group randomly, with 40 cases in each group. Two groups of patients were given routine treatment. The control group were treated with Bifico oral administration on the basis of the treatment. The observation group used Rhubarb ebony decoction enema based on the treatment in control group. The clinical efficacy, awakening time, cognitive ability, liver function, NH3, plasma endotoxin level and adverse reaction were compared between the two groups. ResultsAfter 2 weeks of treatment, the total effective rate of treatment in the control group and the observation group was 75% and 95%, respectively. The difference was statistically significant (P＜0.05). After treatment, the waking time of the patients was significantly shorter than that of the control group (P＜0.01). After 2 weeks of treatment, the MMSE score and HDS-R score of the patients in the observation group were significantly higher than those in the control group (P＜0.01). The levels of TBIL, ALT, AST and PT were significantly lower than those of the control group (P＜0.05). The levels of blood ammonia and plasma endotoxin in the two groups were significantly lower than those before the treatment (P＜0.05). The level of blood ammonia and plasma endotoxin in the observation group was significantly lower than that of the control group (P＜0.05). There was no obvious adverse reaction in the two groups of patients during the treatment. ConclusionRhubarb ebony decoction enema combined with Bifico oral administration in patients with liver cirrhosis complicated with hepatic encephalopathy have significant clinical efficacy. It can effectively improve the liver function of the patients, reduce the disturbance of consciousness, reduce the level of blood ammonia and plasma endotoxin, and improve the safety of the treatment.