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

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 20 g，加水 800 mL煎至 150 mL)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(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(D酶AO)、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。

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

Objective To explore the clinical efficacy of Chinese medicine enema-drip combined with lactulose in the treatment ofhepatic encephalopathy (HE) with heat disturbance and its effect on serum endotoxin, blood ammonia and intestinal mucosal barrierfunction.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-driptreatment. All groups were treated for 1 week. The study observed the changes in the levels of serum endotoxin, blood ammonia, liverfunction indicators [aspartate transaminase (AST), alanine aminotransferase (ALT), total bilirubin (TBil)], inflammatory factors [Tumornecrosis factor-α (TNF-α), interleukin-6 (IL-6)], intestinal mucosal barrier function [diamine oxidase (DAO), D-lactic acid (D-LA)], andtraditional Chinese medicine symptom scores before and after treatment in the three groups. The study also evaluated the improvementtime of mental status, clinical efficacy, and adverse reactions in the three groups.Results There was a significant difference in the im·provement time of mental status among the three groups (P<0.001), in which the combined group (5.84±0.87) d 92.86% in the herbal enema-drip group > 73.81%in the lactulose group. After treatment, there were significant differences in the levels of serum LPS, blood ammonia, TNF-α, IL-6, DAO, D-LA, AST, ALT, TBil, and TCM symptom scores including facial redness, delirium, palpitations, insomnia and dreaminess, drymouth and throat, and irritability among the three groups (all P<0.001). Conclusion The treatment of hepatic encephalopathy with heat disturbance with lactulose and traditional Chinese medicine enema-drip (Sanhuang decoction) is effective in regulating intestinalendotoxins, lowering blood ammonia levels, repairing the intestinal mucosal barrier, shortening the time of mental recovery, improvingliver function, and reducing TCM symptom scores with high safety.