简化门体性肝性脑病指数及其临床应用

目的：本文通过分析苯二氮　类受体抑制剂氟马西尼对临床型肝性脑病患者精神状况的改善情况和乳果糖对亚临床肝性脑病（ＳＨＥ）患者数字连接试验（ＮＣＴ）和脑诱发电位的改善作用，旨在探讨氟马西尼的中枢促清醒作用和乳果糖汁ＳＨＥ的疗效以及推广简化门体分流指数的应用。结果发现（１）氟马西尼治疗前后精神状况级别评分比较有显著性差异（ Ｐ＜０．０５），临床有效率达１０／１２（８３．３％），明显高于醒脑静组的２／１０（２０％）；（２）乳果糖治疗后，临床总有效率为９１．６７％（１／１２），ＮＣＴ和脑诱发电位改善分别为８０％（８／１０）和６６．６７％（６／９），治疗前后门体性肝性脑病指数（ＰＳＥ Ｉｎｄｅｘ）比较有显著性差异（Ｐ＜０．０５）。结果提示氟马西尼对肝性脑病有显著的促清醒作用，乳果糖对ＳＨＥ有显著的改善作用，简化ＰＳＥ　Ｉｎｄｅｘ可在临床推广使用。

The Simplified Portosystemic Hepatic Encephalopathy Index and Its Clinical Uses

The effect of flumazenil (an inhibitor of benzodiazepine receptor)on the mental state of pa- tients with clinical hepatic encephalopathy (HE)was investigated, and the improving actions of lac- tulose on the number connection tests and cerebral evoked potentials in patients with subclinical he- patic encephalopathy(SHE) were also analysed, for the purpose of the verification of flumazenil's waking effect and lactulose's improving effect on SHE, and providing a basis for extensive applica- tion of simplified portosystemic shunt index. The results shoWed: (1) A statistically significant dif- ference between the scores of momal states before and after the flumazenil treatment was observed (P < 0. 05), the clinical effective rate was 10/12(83.3% ) which was Obviously higher than that in Xingnaojing group(20%); (2) The clinical effective rate in lactulose treatment group was 91. 67 % (11/12), the rates of improvement in NCT and cerebral evoked potentials were 80% (8/10 ) and 66. 67 % (6/9), respectively, with statistical difference between portosystemic hepatic encepha- lopathy index (PSE index) before and after the treatment (P < 0. 05). The results indicate that flumazenil has a significant waking effect on HE, lactulose has an improving effect on SHE, and the simplified PSE index is recommended to be more extensively used in the clinical practice.