Urgencias Adultos. Hospital General, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, 02990 Ciudad de México, Mexico; Coordinación de Enseñanza e Investigación. Hospital Regional 1° de Octubre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, 07760 Ciudad de México, Mexico.
Urgencias Adultos. Hospital General, Centro Médico Nacional "La Raza", Instituto Mexicano del Seguro Social, 02990 Ciudad de México, Mexico.
Am J Emerg Med. 2018 Sep;36(9):1570-1576. doi: 10.1016/j.ajem.2018.01.032. Epub 2018 Jan 10.
Hyperammonemia results from hepatic inability to remove nitrogenous products generated by protein metabolism of intestinal microbiota, which leads to hepatic encephalopathy (HE) in chronic liver disease (CLD). In ammonium neurotoxicity, oxidative stress (OxS) plays a pathogenic role. Our objective was to evaluate if intestinal mannitol is as effective and safe as conventional treatment for diminishing hyperammonemia, OxS, and HE in patients with CLD.
We included 30 patients with HE classified by "Haven Criteria for Hepatic Encephalopathy". They were randomized into two groups: 1) Mannitol Group (MG) with mannitol 20% administered into the intestine by an enema, 2) conventional group (CG) with lactulose 40 g enema both substances were diluted in 800 mL of double distilled solution every 6 h; all patients received neomycin. We evaluated ammonia concentration, plasma oxidative stress, HE severity, intestinal discomfort and adverse effects.
Hyperammonemia (171 ± 104 vs 79 ± 49 μmol ammonia/L, p < 0.01), and oxidative stress (MDA 29 vs 27%, formazan 15 vs 11%, carbonyls 16 vs 9% and dityrosines 10 vs 5%) were reduced in MG and CG respectively. The HE severity decreased by two degrees compared to baseline values in both groups. Intestinal discomfort and electrolyte plasma alterations were less frequent (p < 0.05) in MG than CG.
Intestinal mannitol is as effective and safe as conventional treatment for reducing hyperammonemia, oxidative stress, and hepatic encephalopathy of CLD patients in the emergency room. Likewise, mannitol is better tolerated than conventional treatment.
评估肠道甘露醇是否与常规治疗一样有效且安全，可降低慢性肝病（CLD）患者的高氨血症、氧化应激（OxS）和肝性脑病（HE）。
我们纳入了 30 名 HE 分类为“肝性脑病 Haven 标准”的患者。他们被随机分为两组：1）甘露醇组（MG），肠道内给予 20%甘露醇灌肠，2）常规组（CG），给予乳果糖 40g 灌肠，两种物质均在 800ml 双蒸水中稀释，每 6 小时一次；所有患者均接受新霉素治疗。我们评估了氨浓度、血浆氧化应激、HE 严重程度、肠道不适和不良反应。
MG 和 CG 分别降低了高氨血症（171±104 比 79±49 μmol/L，p<0.01）和氧化应激（MDA 29 比 27%，formazan 15 比 11%，羰基 16 比 9%和二酪氨酸 10 比 5%）。与基线相比，两组的 HE 严重程度均降低了两个等级。与 CG 相比，MG 组肠道不适和电解质血浆改变更少见（p<0.05）。
肠道甘露醇与常规治疗一样有效且安全，可降低急诊 CLD 患者的高氨血症、氧化应激和 HE。此外，甘露醇比常规治疗更耐受。
