Helewski Krzysztof J, Kowalczyk-Ziomek Grazyna I, Konecki Janusz J
Katedra i Zakład Histologii i Embriologii SAM, ul. Jordana 19, 41-808 Zabrze.
Wiad Lek. 2002;55(5-6):301-9.
Therapeutic management in hepatic encephalopathy depends on its etiology as well as progression degree. Both in acute and chronic encephalopathy one should tend to establish probable causes and try to eliminate them. Cutting down on proteins in diet is one of the most important suggestions in chronic hepatic encephalopathy. In order to reduce intestinal production of ammonia, non-absorbable disaccharides (lactulose), antibiotics (neomycin) and sodium benzoate are the most commonly used. Branched chain amino acids administered orally or parenterally may be useful in improving patient's condition and restoring the balance of blood amino acids. The GABA-benzodiazepine receptor theory led to application of its antagonists, such as flumazenil, in the management of hepatic encephalopathy. However, providing a proper treatment is not easy due to unstable and often not very characteristic course of hepatic encephalopathy. What is more, clinical trials of some drugs used in the treatment of hepatic encephalopathy do not confirm their effectiveness.
肝性脑病的治疗管理取决于其病因及进展程度。对于急性和慢性脑病，都应设法确定可能的病因并努力消除它们。减少饮食中的蛋白质是慢性肝性脑病最重要的建议之一。为了减少肠道氨的产生，最常用的是不可吸收的双糖（乳果糖）、抗生素（新霉素）和苯甲酸钠。口服或胃肠外给予支链氨基酸可能有助于改善患者状况并恢复血液氨基酸平衡。GABA-苯二氮䓬受体理论促使其拮抗剂如氟马西尼应用于肝性脑病的治疗。然而，由于肝性脑病病程不稳定且往往缺乏典型特征，提供恰当的治疗并非易事。此外，一些用于治疗肝性脑病的药物的临床试验并未证实其有效性。
