Results of using L-ornitin-L-aspartate in the treatment of hepatic encephalopathy in liver transplantation

S. E. Voskanyan, E. Naydenov, A. I. Artemev, D. A. Zabezhinskiy, K. Gubarev, V. Rudakov, M. Shabalin, D. Svetlakova, A. Maltseva, Yu. V. Voskanyan, A. G. Naydenova, M. Muktarzhan, Z. Sadykhov
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Abstract

The aim was to study the results of using various treatment regimens for hepatic encephalopathy for patients with liver cirrhosis before and after liver transplantation and the effect on the incidence and severity of hepatic encephalopathy in the perioperative period, and on the posttransplantation course.Material and methods. Fifty four patients with cirrhosis of various etiologies and the presence of significant hepatic encephalopathy undergoing living donor liver transplantation were included in the study. In the comparison group, patients took lactulose and rifaximin. In the main group, patients took lactulose and rifaximin in combination with L-ornithine-L-aspartate in the preoperative period, and L-ornithine-L-aspartate after liver transplantation for 5 days.Results. The use of L-ornithine-L-aspartate in the complex therapy of hepatic encephalopathy led to significantly reduced time of performing the Number Connection Test, the improvement of cognitive functions in patients by the Montreal Cognitive Assessment, a decreased incidence of stage II–III hepatic encephalopathy and an increased incidence of stage 0-I hepatic encephalopathy in the preoperative period. In the postoperative period, patients of the main group showed a rapid decrease in the severe stages of hepatic encephalopathy (stage II–III) towards less severe forms (stage 0–I) on the 3rd, 5th and 7th days after liver transplantation, and also a faster recovery of cognitive functions, an earlier adequate recovery of consciousness, muscle tone, an earlier possibility of extubation, a shorter length of stay in the intensive care unit, and a decreased postoperative hospital length of stay relatively to the patients of the comparison group.Conclusion. The use of L-ornithine-L-aspartate in the combination therapy for hepatic encephalopathy in the peritransplantation period leads to a significant decrease of the incidence and severity of hepatic encephalopathy, accelerates rehabilitation of patients, reduces postoperative hospital length of stay.
l -鸟嘌呤- l -天冬氨酸治疗肝移植肝性脑病的疗效观察
目的是研究肝移植前后肝硬化患者肝性脑病的不同治疗方案对围手术期肝性脑病发病率、严重程度及移植后病程的影响。材料和方法。54例不同病因的肝硬化和存在显著肝性脑病的患者接受活体供肝移植。对照组患者同时服用乳果糖和利福昔明。主组患者术前服用乳果糖、利福昔明联合l -鸟氨酸- l -天冬氨酸,肝移植后服用l -鸟氨酸- l -天冬氨酸5 d。在肝性脑病综合治疗中使用l -鸟氨酸- l -天冬氨酸可显著缩短执行数字连接测试的时间,改善蒙特利尔认知评估患者的认知功能,降低术前II-III期肝性脑病的发病率,增加0-I期肝性脑病的发病率。术后,主组患者肝移植后第3、5、7天重型肝性脑病(II-III期)向轻重型肝性脑病(0-I期)迅速减少,认知功能恢复较快,意识、肌张力恢复较早,拔管可能性较早,重症监护室住院时间较短;与对照组相比,术后住院时间明显缩短。移植围期应用l -鸟氨酸- l -天冬氨酸联合治疗肝性脑病,可显著降低肝性脑病的发生率和严重程度,加快患者康复,缩短术后住院时间。
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