目的:探讨通腑降浊汤在热扰心神型肝性脑病患者治疗中的应用价值,观察其对患者炎性指标、肠黏膜屏障功能的影响,旨在为本病提供有效的治疗手段。方法:将2018年7月至2019年7月因肝性脑病于我院就诊且中医证型属于热扰心神型的76例患者纳入研究,用随机数字表法分组。所有患者均常规采用护肝降酶治疗,在此基础上对照组38例口服乳果糖,观察组38例联合通腑降浊汤灌肠治疗,治疗1周后比较临床疗效及实验室检查指标。结果:治疗后观察组血清内毒素(LPS)、血氨水平低于对照组,差异具有统计学意义(P<0.05);治疗后观察组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平低于对照组,凝血酶原活动度(PTA)水平高于对照组,差异具有统计学意义(P<0.05);治疗后观察组血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)水平低于对照组,差异具有统计学意义(P<0.05);治疗后观察组血清二胺氧化酶、D-乳酸等肠黏膜功能屏障指标水平低于对照组(P<0.05);治疗后观察组烦躁不安、乏力、嗜睡等症状积分水平低于对照组(P<0.05);观察组总有效率89.47%(34/38),高于对照组的68.42%(26/38),差异具有统计学意义(P<0.05)。结论:对于热扰心神型肝性脑病患者,通腑降浊汤灌肠治疗具有重要意义,可有效减轻炎症反应,改善肠黏膜屏障功能,改善凝血功能,促进病情好转。

Objective:To explore the application value of Tongfu Jiangzhuo Decoction (通腑降浊汤 ) in the treatment hepatic encephalopathy(heat disturbing heart mind type),and to observe its effect on inflammatory indexes and intestinal mucosal barrier function,in order to provide an effective treatment for this disease.Methods:A total of 76 patients with liver encephalopathy of heat disturbing heart mind type treated in our hospital from July 2018 to July 2019 were included in the study and divided into different groups with a random number table. All patients were routinely treated with treatment for liver-protecting and enzymereducing. Besides this,38 patients in the control group received oral lactulose,and 38 patients in the observation group were treated with enema using traditional Chinese medicine Tongfu Jiangzhuo Decoction. The clinical efficacy was compared 1 week after the treatment. Results:Plasma lipopolysaccharide(LPS) and blood ammonia levels in the observation group after treatment were lower than those in the control group,and the differences were statistically significant(P<0.05);in the observation group after the treatment tumor necrosis factor(TNF)-α and interleukin(IL)-6 levels were lower than those in the control group,and prothrombin activity(PTA) levels were higher than those in the control group,with statistical differences(P <0.05);plasma total bilirubin(TBIL) and alanine aminotransferase(ALT) levels in the observation group after treatment were lower than those in the control group,and the differences were statistically significant(P<0.05);after the treatment,in the observation group plasma diamine oxidase,D-lactic acid were lower than those in the control group(P<0.05);after the treatment,the scores of irritability,fatigue,and somnolence in the observation group were lower than those in the control group(P<0.05);the total effective rate in the observation group was 89.47%(34/38),higher than 68.42%(26/38)in the control group,and the difference was statistically significant(P<0.05). Conclusions:For patients with hepatic encephalopathy( heat disturbing heart mind type), it is of great significance to combine Tongfu Jiangzhuo Decoction enema,for it can effectively reduce the inflammatory response,improve the intestinal mucosal barrier function,improve the coagulation function,and improve the condition.