论文部分内容阅读
目的多器官功能不全是重型肝炎患者死亡的主要原因,大部分患者因不能及时进行肝脏移植而死亡。如何有效的防治重型肝炎多器官功能不全,为患者赢得肝脏移植的时机,是降低其病死率的关键。本研究目的是观察重组人生长激素(rhGH)联合乳果糖肠道滴注防治慢性重型肝炎患者并发症的疗效,并对其作用机制进行了初步的探讨。材料与方法1999年1月～2002年2月住院的慢性重型肝炎患者48例。向患者或家属说明治疗方法,同意使用人生长激素者入治疗组,否者入对照组。治疗组28例,对照组20例。治疗方法:①人生长激素(国产)4～4.5u/次,qd,肌内注射,连续2～4周;②0.9％生理盐水100ml+乳果糖30ml+灭滴灵2.0克/次,qod,肠道滴注,2～4周;两组的基础治疗基本一致。根据修改的疗效标准判断其效果。结果治疗组大部分患者临床症状明显改善,显效率21.4％(6/28);有效率53.5％(15/28),总有效率75％;血清前白蛋白、白蛋白、IGFBP1、胆固醇水平明显增加(P<0.05);而对照组显效率为5％(1/20),有效率为35％(7/20)。总有效率40％,约60％患者前白蛋白、白蛋白、IGFBP1、胆固醇水平持续下降。结论生长激素能明显改善慢性重型肝炎患者的蛋白质代谢,肠道滴注乳果糖能较有效的控制肠源性内毒素,可能防止并发症的发生、发展。我们的研究结果提供了一些初步的依据:人生长激素联合乳果糖可能对防治重型肝炎并发多器官功能不全具有较好的作用。
Purpose Multiple organ dysfunction is the main cause of death in patients with severe hepatitis, most patients died of liver transplantation can not be timely. How to effectively prevent multiple organ dysfunction in patients with severe hepatitis, liver transplantation for patients to win the opportunity to reduce the mortality of the key. The purpose of this study was to observe the efficacy of recombinant human growth hormone (rhGH) combined with lactose instillation in the prevention and treatment of complications of patients with chronic severe hepatitis, and its mechanism of action was initially explored. Materials and Methods From January 1999 to February 2002 in 48 patients with chronic severe hepatitis. Explain to patients or their families treatment, consent to the use of human growth hormone into the treatment group, or into the control group. 28 cases in the treatment group and 20 cases in the control group. Treatment: ① human growth hormone (domestic) 4 ~ 4.5u / times, qd, intramuscular injection for 2 to 4 weeks; ② 0.9% saline 100ml + lactulose 30ml + metronidazole 2.0g / times, qod, Road drip, 2 to 4 weeks; basic treatment of both groups basically the same. According to the revised efficacy criteria to determine its effect. Results The clinical symptoms of most of the patients in the treatment group were significantly improved. The effective rate was 21.4% (6/28), the effective rate was 53.5% (15/28) and the total effective rate was 75%. The levels of serum prealbumin, albumin, IGFBP1 and cholesterol were significantly (P <0.05); while in the control group, the effective rate was 5% (1/20) and the effective rate was 35% (7/20). The total efficiency of 40%, about 60% of patients prealbumin, albumin, IGFBP1, cholesterol levels continued to decline. Conclusion Growth hormone can significantly improve the protein metabolism in patients with chronic severe hepatitis. Intestinal instillation of lactulose can effectively control intestinal endotoxin, which may prevent the occurrence and development of complications. Our results provide some preliminary evidence: human growth hormone combined with lactulose may play a good role in the prevention and treatment of multiple hepatitis with multiple organ dysfunction.