肝性脑病治疗（Hepatic encephalopathy treatment）.docVIP

肝性脑病治疗（Hepatic encephalopathy treatment） First, treatment incentives Most hepatic encephalopathy have obvious causes: digestive tract bleeding, massive ascites, massive potassium excretion, diuresis, constipation, uremia, high protein diet, taking sleeping pills or anesthetics, infection, etc.. These triggers are avoidable or treatable. The most basic strategy is to cure the cause and avoid the occurrence and further development of hepatic encephalopathy. Two. Treatment based on the hypothesis of ammonia toxicity (1) reducing ammonia production; 1. diet instruction Patients with hepatic encephalopathy need to control dietary protein intake. In patients with a history of hepatic encephalopathy, protein intake should not exceed 70g/d, but not less than 40g/d, so as to avoid negative nitrogen balance. When encephalopathy occurs, the intake of protein should be strictly controlled. The energy supply is mainly carbohydrates, and the daily supply of calories is 1200~1600 kcal. But SHE does not have to fast protein. SHE management should be based on the structure of plant proteins or mixed proteins of plants and animals. 2. enema or catharsis About 50% of the ammonia in the human gut is produced by colon bacteria, so cleaning the intestines is a quick and effective way. Clear the intestinal indigestion and blood or other nitrogenous substances available, saline, phosphate or weak acid solution enema, oral or nasal feeding, 25% Magnesium Sulfate 30 ~ 60ml catharsis. 3. do not absorb disaccharides (1) lactulose Lactulose is a synthetic disaccharides (lactose and fructose), human intestinal cells were no disaccharide lactulose enzymatic decomposition, so dont be intestinal absorption of lactulose. The onset of the initial position in the colon, colonic flora by lactulose glycolysis, increased stool frequency, thereby reducing the ability to convert ammonia or alpha ketoglutarate intestinal glutamine, thereby reducing ammonia load, reduce the level of blood ammonia. Lactulose