1 1 What are the commonly used liver-protecting drugs? What are the characteristics of each? 2 What are the commonly used immunomodulators? What are the characteristics of each? 3. What are the main antiviral treatments for chronic hepatitis B? What is the effect of each? 4 Which patients should not be treated with lamivudine? 5 How is acute hepatitis treated? 6 How is chronic hepatitis B treated? 7 What to do with "Little Sanyang"? What to do with "Big Three Suns"? 8 How can I turn hepatitis B virus surface antigen (HBsAg) and e-antigen (HBeAg) negative? What should I do if it never turns negative? 9. Can acupoint drug injection make the e-antigen (HBeAg) negative? 10 What should I do if a hepatitis B patient cannot receive antiviral treatment? 11 How to treat severe hepatitis? How to deal with concurrent infections? 12 What is the effect of hepatocyte growth factor, prostaglandin E1, and glucagon-insulin in treating severe hepatitis? 13. Can severe hepatitis be treated with antiviral therapy? 14 How is cholestatic hepatitis treated? 15. What are the special features of the treatment of pediatric hepatitis? 16 How is viral hepatitis treated during pregnancy? 17. What should we do if hepatic ascites occurs in patients with hepatitis during pregnancy? 18. How to treat pregnant women suffering from severe hepatitis? 19. What should I do if the jaundice of hepatitis patients persists? 20 What should I do if the aminotransferase of hepatitis patients does not decrease for a long time? 21 How to deal with hepatitis patients accompanied by hiccups? 22 How is liver fibrosis treated? 23 How effective is drug acupoint injection in treating liver fibrosis? 24 How is cirrhosis treated? 25 How to treat hepatic encephalopathy in patients with hepatitis? 26 Hepatorenal syndrome occurs in patients with hepatitis and how to treat it? 27 How to treat liver cirrhosis complicated by primary peritonitis? 28 How to treat upper gastrointestinal bleeding in post-hepatitis cirrhosis? 29 How to deal with ascites in patients with hepatitis and cirrhosis? 30 What should patients with liver cirrhosis and gastric disease do? 31 What are the drugs that reduce hepatic portal venous pressure? How to choose? 32 What are the common surgical methods for the surgical treatment of portal hypertension? 33 What is the role of transjugular intrahepatic portocaval shunt in the treatment of portal hypertension? 34 Under what circumstances should splenectomy be performed in patients with post-hepatitis cirrhosis? 35 What are the common complications after portal hypertension surgery? How to prevent and treat it? 36. What should I do if patients with viral hepatitis and liver cirrhosis are complicated with biliary tract infection and cholelithiasis? 37 What are the preoperative and postoperative treatments for patients with liver cirrhosis? 38. What are the dangers during anesthesia for patients with liver dysfunction? What should I pay attention to before anesthesia? 39 Why is viral hepatitis sometimes treated with hyperbaric oxygen? 40 What is an artificial liver? How effective is it? Who needs an artificial liver? 41 What is liver transplantation? How effective is it? Who needs a liver transplant? 42 How to treat fatty liver? 43 What drugs should patients with hepatitis use with caution? Will Chinese herbal medicine cause liver damage? 44 Normal values ??and clinical significance of new liver function items 45 Normal values ??and clinical significance of commonly used liver function tests 46 Why does serum phosphatase (AKP) increase in hepatobiliary diseases? 2 47 Why does the test require fasting blood? 48 What should we pay attention to when testing blood lipids? 49 What are the commonly used liver-protecting drugs for hepatic hemangioma and liver cysts? What are the characteristics of each? At present, there are many drugs for the treatment of liver diseases, which can generally be divided into the following categories: 1 1) Silymarin has a stabilizing effect on cell membrane structure and cell metabolism, can resist necrosis of liver cells, reduce fatty degeneration, promote protein synthesis, and inhibit alanine amino acid The increase in transferase can be used to treat various types of viral hepatitis, drug-induced hepatitis, and alcoholic hepatitis. Currently, the commonly used clinical drugs are Yiganling, cilbinamine (silybin meglumine), and compound Yiganling (compound tablets of silymarin and cinnamonol). Usage of each medicine: Yiganling: 38.5 mg per tablet, 3 times a day, 2 tablets each time. Cilibinamine tablets: 50-100 mg each time, 3 times a day. Compound Yiganling; 3-4 tablets each time, 3 times a day. There are no obvious side effects after long-term use. 2) Salvia miltiorrhiza has the effects of promoting blood circulation and removing blood stasis, nourishing blood and calming the nerves. In recent years, studies have found that Salvia miltiorrhiza can improve intrahepatic microcirculation, reduce blood viscosity, reduce hepatic portal vein pressure, regulate immune function, promote liver cell regeneration, resist liver fibrosis, dissolve early-formed liver fibrosis, and have anti-tumor effects. . It can be used as one of the most basic drugs for the treatment of acute jaundice hepatitis, chronic hepatitis, severe hepatitis and cholestatic hepatitis.
Usage: 10-20 ml of compound Danshen solution, add 5%-10% glucose solution for intravenous drip, or 2-3 Danshen tablets, 3 times a day. 3) Liver preparations such as liver extract, liver essence, and liver extract are a traditional medicine used in many countries. They are rich in vitamins B2, B12, folic acid, hepatocyte stimulating factor, purine nucleosides and various amino acids. Mainly used as a medicine for blood diseases, it has a repairing effect on liver cells caused by experimental liver damage. A large group of controlled clinical trials have been conducted, and it is believed that it is indeed effective in treating chronic hepatitis and cirrhosis. 4) Inosine can directly enter cells, participate in substance metabolism, and can restore damaged liver cells, improve organ function, and may also be effective in reducing leukocytes and platelets. Usage: Take inosine orally, 0.2-0.4 grams each time, 3 times a day. 5) Adenosine triphosphate (ATP) is the main source of cellular energy, plays an important role in regulating many metabolic processes, and promotes the repair of liver cells. Usage: Orally, 40 mg each time, 3 times a day. Add 20-40 mg to 500 ml of glucose each time and infuse intravenously once a day. Individual patients may have allergic reactions. excessive. Too fast may cause hypotension and dizziness. 6) Coenzyme A is mainly involved in the oxidative metabolism of substances and is beneficial to the recovery of liver function; usage: intravenous infusion, 50 units each time, add 500 ml of 5%-10% glucose, once a day. 7) Cytochrome C is a very important electron transmitter in biological oxidation and participates in the cellular respiration process. Usage: intravenous infusion, 15-30 mg each time added to 500 ml of 5%-10% glucose injection, once a day. Be careful to prevent allergic reactions. Do a skin allergy test before use. 8) Glucuronolactone: Glucuronolactone combines with bilirubin, metabolic waste, drugs, and toxins, and is excreted from the bile and has a detoxifying effect. Usage: Take orally, 0.1-0.2 g each time, 3 times a day. Intramuscular injection, 0.1-0.2 g each time, 1-2 times a day. 2 1) Glycyrrhizic acid preparations mainly include Qianglixin, Ganlixin and glycyrrhizin tablets. The main ingredients of Duratronin are 0.7% glycyrrhizic acid (glycyrrhizin), 0.9% cysteine ??and 2% glycine. Dianliang Ning has adrenocortical hormone-like effects but no hormonal side effects; it can be choleretic, detoxifying, inhibiting the production of free radicals and the formation of peroxidized lipids in the body, and has the effects of reducing jaundice and aminotransferase, and can be used to treat acute hepatitis, Chronic hepatitis, severe hepatitis. Usage: Take 100-120 ml of Qianglanin, add 250-500 ml of 10% glucose, and infuse intravenously once a day, 2 months as a course of treatment, and can be used for 2-3 courses. After the liver function has basically recovered, the dose will be reduced gradually. Stop the medication. Side effects include hypertension, edema, and hypokalemia. Ganlixin is a new generation of similar products, and its efficacy seems to be slightly higher than that of Dianlixin. Glycyrrhizin tablets are oral preparations. Usage: Take orally, 150 mg each time, 2 times a day, for 3-6 months. 2) Matrine is a total alkaloid extracted from the seeds of the sophora plant of the genus Leguminosae. It is cold in nature and bitter in taste. It has the effects of clearing away heat and diuresis, reducing yellowing, detoxifying and diuretic. Ginseng relieves liver inflammation and lowers enzymes quickly. It may rebound after stopping the drug, but repeated application can still be effective, and it also has a certain antiviral effect. Usage: Add 150 mg of matrine into 500 ml of glucose solution, intravenous drip, once a day, 1-3 months as a course of treatment. Adverse reactions such as dizziness, palpitations, and dryness of the mouth and throat may occur. 3) Colchicine is an alkaloid extracted from the plant Colchicum. Animal experiments and clinical studies have shown that colchicine can relieve liver inflammation. It is mainly used for chronic hepatitis and liver cirrhosis with obvious disease activity. Colchicine also has anti-hepatic fibrosis effect. However, due to its high toxicity, it is rarely used. Usage: 0.5 mg each time, 2 times a day. 3 1) Diphenyl diester Diphenyl diester is an intermediate product of the synthesized Schisandrin, which has the function of reducing the leakage of alanine aminotransferase (ALT) from the liver cell membrane and improving liver detoxification. Clinically, the recent enzyme-lowering effect is about 90%, and usually returns to normal within 4 weeks. However, it is ineffective in reducing serum aspartate aminotransferase (AST). It is mostly used for chronic hepatitis with mild or no jaundice. Patients with jaundice, chronic hepatitis or active cirrhosis should use with caution. The long-term efficacy of diphenate is not strong enough. About half of the patients will have a "rebound" in ALT after stopping the drug. In cases of "rebound", the serum ALT will still drop significantly after taking diphenate.
The recovery of liver lesions is slower than the recovery of ALT, so it is not advisable to stop the drug immediately even if ALT returns to normal. Usage: Take biphenyl ester orally, 5-10 capsules each time, 3 times a day, for 3 months, or after the ALT level drops to normal, you must continue taking the drug for 2-3 months, and then gradually reduce the dosage. Adverse reactions are rare. 2) Schisandra chinensis Schisandra chinensis is a good medicine that nourishes qi and nourishes the five internal organs. It has no side effects after being taken for a long time. The drug has the function of protecting the liver, promoting protein synthesis in the liver and regeneration of liver cells, and enhancing the detoxification function of the liver. It can significantly reduce serum ALT, but ALT will "rebound" after stopping the drug, which generally requires medication for more than half a year. It is generally not used alone, but is often combined with other liver-protecting drugs to form a compound preparation. 3) Trichosanthes kirilowii has heat-clearing, detoxifying and diuretic effects, and has a good enzyme-lowering effect on both acute and chronic hepatitis patients. Its enzyme-lowering effect is fast and large, but it also has a rebound effect. Usage: Take orally, 10-20 grams each time, 3 times a day. Generally, the medication needs to be taken for more than half a year. 4) Shantougen Injection (Ganyanling) is an alkaloid extracted from Shantougen. It can reduce the degeneration and necrosis of liver cells, promote the regeneration of liver cells and the synthesis of albumin, reduce the synthesis of globulin, and regulate immunity. Function. The enzyme-lowering effect is obvious, but it can also rebound after stopping the drug. Usage: Ganyanling Injection is injected intramuscularly, 4 ml each time, once a day, 2-3 months is a course of treatment, and one course of treatment can be repeated, and the dosage should be gradually reduced. At the usual dosage, there are no obvious side effects. 4 1) Phenobarbital is a long-acting sedative-hypnotic agent. Because of its enzyme-inducing effect, it can be used to reduce jaundice in liver disease. Mechanism of action: 1) Induces uracil diphosphate glucuronosyltransferase to promote the excretion of bilirubin; 2) Induces Y protein in the liver to promote bilirubin transport; 3) Induces cholesterol-degrading enzyme to promote the decomposition of cholesterol into cholic acid, Excreted from the body. It is mainly used clinically for cholestatic hepatitis. Phenobarbital may cause slight damage to the liver, and must be used with caution in hepatitis with severe liver function damage. Usage: Phenobarbital is taken orally, 30-60 mg each time, 3 times a day, and the course of treatment is generally 4-8 weeks. Usually jaundice begins to decrease 5-7 days after treatment, and bilirubin levels can decrease by 40%-60% within 2 weeks. 2) Ursodeoxycholic acid interferes with the absorption of cholic acid and chenodeoxycholic acid in the small intestine, thereby reducing bile salts in the blood and having a choleretic effect. It can be used for chronic hepatitis, cholestatic hepatitis, cirrhosis, primary biliary cirrhosis and primary sclerosing cholangitis. Usage: Orally, 2 times a day, 5 mg per kilogram of body weight each time. 3) Afentrisulfide (bilivitamin) has the effect of protecting the liver and promoting bile secretion. Usage: Orally, 25 mg each time, 3 times a day. 4) Kuhuang Injection is a sterile injection extracted from five traditional Chinese medicines: Sophora flavescens, rhubarb, artemisia, Bupleurum and Daqingye. Among them, Yinchen and rhubarb both have good anti-jaundice effects. Bupleurum can soothe the liver and relieve stagnation and introduce medicine into the liver meridian. Sophora flavescens and Daqingye can clear away heat, detoxify and diuretic. Therefore, bitter yellow has the effects of diuresis, anti-jaundice and clearing away heat. Detoxification effect. Usage: Add 30-60 ml of Kuhuang Injection to 250-500 ml of 5%-10% glucose solution for intravenous infusion, once a day, 15 days as a course of treatment, and can be used repeatedly. 5) Yinzhihuang Injection is composed of 12 mg of Yincheng extract, 6.4 mg of gardenia extract, and 40 mg of baicalin. It has the effects of clearing away heat, detoxifying, diuresis, and reducing jaundice. Yinzhihuang has the following effects in treating hepatitis: 1. It can increase the liver's ability to absorb, combine and excrete bilirubin by inducing the liver enzyme system; 2. Reduce liver parenchymal inflammation, prevent hepatocyte degeneration and necrosis, and promote liver cell repair and regeneration; 3. Enhance liver detoxification function, increase glycogen accumulation in liver cells, and have antibacterial effects. It is clinically used to treat jaundice hepatitis, including acute and chronic hepatitis and severe hepatitis. Usage: Dissolve 10-20 ml of Yinzhihuang injection in 250-500 ml of 10% glucose solution for intravenous drip, once a day. After the symptoms are relieved, it can be switched to intramuscular injection, 2-4 ml per day. A course of treatment lasts for 2-4 weeks and can be used repeatedly. 6) Potassium and magnesium aspartate, also known as pulse stabilization, contains aspartic acid, potassium ions, magnesium ions, etc. It was first used to treat arrhythmias caused by digitalis poisoning, and was later found to have anti-jaundice effects. Aspartic acid is the precursor of oxaloacetate in the human body and plays an important role in the cycle of tricarboxylic acid and ornithine, causing ammonia (NH3) and carbon dioxide to produce uremia, which is required by liver cells to maintain their normal function. Essential biochemical proxy. Potassium ions are necessary for cell life and are a catalyst for the synthesis and decomposition of high-energy phosphate compounds.
Magnesium ions are indispensable substances for the production of glycogen and high-energy phosphates. They are active catalysts for many enzymes in sugar metabolism and can also enhance the therapeutic effect of potassium aspartate. Potassium magnesium aspartate is clinically used to treat icteric hepatitis, which can accelerate the disappearance of jaundice and improve clinical symptoms. In addition, potassium magnesium aspartate can also be used to treat hepatic encephalopathy. Usage: Add 20-40 ml of potassium and magnesium aspartate to 250-500 ml of 10% glucose for intravenous drip or intravenous injection. A course of treatment lasts for 2-4 weeks and can be used repeatedly. How is acute hepatitis treated? 10 50 (1) Active rest refers to bed rest in the acute phase and moderate activities in the recovery phase. 4 (2) Diet should provide adequate protein and various vitamins to facilitate the repair and regeneration of liver cells. However, when nausea and vomiting are severe in the acute phase, light, easy-to-digest food should be given. After the jaundice subsides and the appetite improves, you can eat some lean meat, eggs, fish, tofu, fresh vegetables, fruits, etc. Some patients emphasize "taboos" and dare not eat meat, or buy soft-shell turtles at high prices to "nourish" them, or eat a lot of sugar to "protect the liver". This is a certain one-sided understanding. (3) Hepatoprotective treatment mainly protects liver function and reduces aminotransferase, such as Schisandra chinensis preparations, diphenyl diester, Chuibencao granules, Qianglining, Ganlixin, Ganyanling, Tianjihuang, etc. are commonly used enzyme-lowering drugs. . It can also be supplemented with vitamins C, B6, E and inosine. (4) Anti-jaundice anti-inflammatory and choleretic tablets, Kuhuang Injection, Yinzhihuang Injection, potassium aspartate, etc. all have good anti-jaundice effects. Ursodeoxycholic acid can be used to accelerate the anti-jaundice treatment of cholestatic hepatitis. (5) For symptomatic treatment, patients with loss of appetite can be treated with intravenous infusion of glucose and vitamin C, and oral administration of multi-enzyme tablets or hawthorn granules; patients with nausea and vomiting can be treated with oral metoclopramide (metoclopramide), and intramuscular injection can be given if the symptoms are not relieved. 1-2 times a day; those with obvious abdominal distension can take high-efficiency anti-bloating tablets; those with jaundice accompanied by skin itching can take cholestyramine, aluminum hydroxide, chlorpheniramine (chlorpheniramine), etc. (6) Traditional Chinese medicine has a good therapeutic effect on acute hepatitis. For those whose clinical symptoms are not severe and whose jaundice is not deep, they can use heat-clearing and detoxifying Chinese herbal medicines, such as Ganshule Granules (Yinchen, Prunella Vulgaris, Bupleurum, Imperata Root, Dandelion, Jujube, etc.). For those with severe illness, treatment should be based on TCM syndrome differentiation. If the heat is more severe than the dampness, Yinchenhao Decoction should be used; if the dampness is more severe than the heat, Yinchenhao Decoction should be used; if dampness and heat are both severe, Yinchenhao Decoction should be used. And Silingsan addition and subtraction, etc. (7) Antiviral therapy For hepatitis C, early use of interferon can prevent chronicity, with high efficacy (>70%) and less chance of recurrence. Commonly used regimen: 3 million units of interferon, intramuscular or subcutaneous injection 3 times a week or once every other day, for 3 months. After entering the recovery period, you only need to take some commonly used liver-protecting drugs, such as vitamin C, vitamin B complex, inosine tablets, yeast tablets, multi-enzyme tablets, Gansule, Chuipencao, etc., and choose 2-3 specifically. However, be careful not to take too much or too many medications, which will increase the burden on the liver and affect recovery. Patients in the recovery stage of acute hepatitis B are often given some drugs to regulate the body's immune function, such as fungal polysaccharides. The medication time is generally 2-3 months, but liver function still needs to be reviewed regularly. The specific time can also be determined by the doctor at his or her discretion based on liver function and clinical manifestations. Patients with chronic hepatitis B suffer from immune dysfunction and continued replication of hepatitis B virus, resulting in inflammation, necrosis and liver fibrous tissue hyperplasia of liver cells, hepatic microcirculation blood flow stasis, liver sinusoidal capillaryization, liver ischemia, hypoxia and metabolism. disorders, some are also combined with extrahepatic lesions, and the clinical signs are complex and changeable. The treatment principle of chronic hepatitis B: emphasizing three points of drug treatment and seven points of conditioning. You must have the confidence and will to defeat the disease, be in a happy spirit, have a regular life, pay attention to a reasonable diet arrangement, and avoid obesity caused by excessive nutrition. Except for bed rest when jaundice or aminotransferase is significantly increased, the symptoms generally are not many. When aminotransferase is slightly elevated, you should exercise moderately and pay attention to the combination of movement and stillness. Drug treatment: Due to the persistence and replication of hepatitis B virus (HBV), it is not easily cleared by the body's immune function and therapeutic drugs, resulting in continued progression of liver lesions. Therefore, antiviral-based comprehensive treatment is adopted. (1) Antiviral treatment mainly uses interferon α and nucleoside analogs. Interferon is injected daily at 5 million units for the first 10-30 days, and then injected 3 times a week, 5 million units each time, with a 24-week course of treatment.
Nucleoside analogues currently used include lamivudine (0.1 g, once a day, for at least 1 year), famciclovir (0.25-0.5 g, three times a day, for 16 weeks), adefovir (10 mg, once a day, 12 weeks of treatment). It is currently advocated that the combined use of antiviral drugs or the combination of antiviral drugs and immunomodulatory drugs can improve the efficacy. (2) Immune-modulating drugs 1: Immune enhancers, among which thymosin α1 (Zidaxian) can indirectly inhibit HBV replication by regulating the body's immune function. In addition, there are interleukin-2, immune ribonucleic acid, specific transfer factors, lentinan, levamisole, etc. that can promote the recovery of the body's cellular immune function; 2: Immunosuppressants: such as adrenocortical hormones and glycyrrhizin, etc., but the use of hormones requires careful. (3) Liver-protecting and supportive treatment drugs 1: Liver-protecting drugs: such as inosine, energy mixture, liver extract, etc.; 2: Inflammation-relieving drugs: such as hormones, glycyrrhizin, matrine, colchicine, etc.; 3: Enzyme-lowering drugs: such as biphenyl diester, Schisandra chinensis, Schisandra chinensis, etc.; 4: Anti-jaundice drugs: such as phenobarbital, ursodeoxycholic acid, etc. (4) Anti-liver fibrosis drugs such as interferon gamma, colchicine, Biejia Ruangan Tablets, Dahuang Zhechong Pills, etc. (5) Other hepatocyte growth factors, prostaglandin E1, and insulin-glucagon (G-I) can promote liver cell regeneration; Wuji Baifeng Pills can improve frailty, promote protein synthesis, and may also have anti-liver fibrosis effects. effect. It should be emphasized that during the long treatment period of chronic hepatitis B, you must not abuse too many drugs and use liver-damaging drugs, and do not seek medical treatment indiscriminately or change medicines too frequently. """" Some people infected with hepatitis B virus test "two and a half", showing positive surface antigen (HBsAg), e-antibody (anti-HBe) and core antibody (anti-HBc), commonly known as "small three positives". This usually means that hepatitis B virus (HBV) replication has gradually become quiescent, the number of viruses has decreased, the infectivity is weak, and the disease has begun to enter the recovery phase. However, studies have found that 30%-40% of "small 5 triple positives" are caused by mutations in the pre-C region gene of HBV, which prevents the expression of the e antigen (anti-HBeAg), resulting in "false small triple positives". In essence, the hepatitis B virus is still During replication, the inflammatory activity of hepatocytes continues, and a considerable proportion of patients with chronic hepatitis, cirrhosis and even liver cancer are clinically anti-HBe positive. Therefore, patients with "small three positives" should undergo HBVDNA testing (preferably quantitative HBVDNA) and B-ultrasound examination. Positive HBVDNA means there is HBV pre-C gene mutation, indicating that the disease is still continuing or developing, and antiviral treatment is required if necessary. B-ultrasound examination can understand liver inflammation. "Big Three Positives" refers to HBsAg, HBeAg, and anti-HBc positivity, indicating obvious viral replication and strong infectivity. "Big three yang" can appear in chronic inflammation and HBV carriers. For HBV carriers, because the body is in the immune tolerance stage, antiviral treatment is not effective. Generally, liver function should be checked regularly, and antiviral treatment should be considered when the disease becomes active (ALT increases). For chronic hepatitis, the treatment plan should be determined based on the liver function. If the patient's ALT rises to about 200 units, it means that the liver inflammatory activity is obvious, which is a good opportunity for antiviral treatment. Interferon, lamivudine can be used alone or combined with them respectively. Combination treatment with matrine and other drugs. HBsAg e HBeAg The main purpose of our application of antiviral drug treatment is to turn the e-antigen (HBeAg) negative, and then the e-antibody (anti-HBe) becomes positive (that is, to turn the "big three yang" into "small three yang"), and finally turn the e-antibody (anti-HBe) positive. Turn anti-HBe negative. HBeAg negative occurs in the following situations: 1) Natural conversion: For those who are infected with hepatitis B virus due to horizontal transmission (transmission caused by contact with patient's blood and body fluids) in adulthood, due to the impairment of immune function As a result, 10%-20% of HBeAg becomes negative every year, but for patients with mother-to-child transmission or infections in infants and young children, the HBeAg negative rate is much lower (3%-5%); 2: Conversion after acute attack Yin: As the body's immune function is activated, immune cells attack the hepatitis B virus located in liver cells, causing damage to the liver cells and suppressing the virus. At this time, a transient increase in alanine aminotransferase may occur; 3: Apply anti- Viral drugs: For example, interferon can make the patient's HBeAg negative conversion rate reach 30%-40%, and lamivudine can make the patient's HBeAg negative conversion rate reach 20% in the first year, and can reach 30% in the second, third, and fourth years. Around 40% and 50%.
Due to the low natural conversion rate of HBeAg, antiviral drugs can only convert some cases to negative. Therefore, HBeAg-positive patients are currently treated with combined antiviral drugs, such as interferon + nucleoside drugs, interferon + nucleoside drugs, and nucleoside drugs. Glycoside drugs + cytokines, combination of two nucleoside drugs (lamivudine + famciclovir), interferon + matrine, lamivudine + matrine, etc. The key is to correctly grasp the antiviral treatment opportunity. In addition, it is also important to adjust immune function. Most of the currently used immune function enhancers are non-specific, and the curative effects are unsatisfactory. Currently, researchers at home and abroad are working hard on gene therapy in the hope of making breakthroughs. In acute hepatitis B, most of the hepatitis B virus surface antigen (HBsAg) turns negative about 2-3 months after the onset, and only about 10% remain positive. After 12 weeks, it turns into chronic hepatitis. The annual natural negative conversion rate after chronic hepatitis B virus infection is very low, only 1%-2%. Although antiviral treatment can make HBeAg negative, the HBsAg negative conversion rate has not significantly improved. Some people infected with hepatitis B virus carry surface antigens for life. Research is currently being conducted to explore whether acupoint drug injection can eventually turn e-antigen (HBeAg) negative. Since there is no specific treatment for chronic hepatitis so far, continued positive e-antigen has a great impact on the patient's health. The Department of Integrated Traditional Chinese and Western Medicine of the Second Hospital of Nanjing City, on the basis of achieving good results with acupoint acupuncture in the treatment of chronic hepatitis, has successively used acupoint injection of vitamin K1, compound salvia miltiorrhiza, matrine, and thymosin to treat chronic active hepatitis, and established nursing facilities at the same time The liver drug group was used as a control. The results showed that the ALT reduction rate, especially the e-antigen negative conversion rate, in the acupoint injection group was significantly higher than that in the drug treatment group. Acupoint injection therapy is based on the action of acupuncture to stimulate acupuncture points on the body surface and regulate the body's immunity and physiological functions to treat corresponding organ diseases. It is in line with the regularity of the specific internal relationship between the body surface-meridians-organs in traditional Chinese medicine. Vitamin K1 has a "hormone-like" effect, which can enhance intestinal peristalsis and secretion function, and increase the endocrine activity of the thyroid gland. It is also an oily substance, which is slowly absorbed after being injected into acupoints, thus continuously stimulating acupoints. Some domestic authors have discussed the mechanism of acupoint injection in the treatment of chronic hepatitis. Some have measured the levels of serum interferon and blood zinc in patients before and after acupoint injection. They found that 2 months after injection, the interferon level and blood zinc content were both higher than those of acupoint injection. However, the specific mechanism of e-antigen conversion is under in-depth study. Because viral replication can cause damage to liver cells, antiviral treatment is an important "fundamental" measure. However, some patients often do not have the conditions for antiviral treatment. There are two main reasons: First, economic reasons. Since the efficacy of existing antiviral drugs is not very high, often a drug cannot "turn negative" in one course of treatment, and several treatments are needed. Courses of treatment and combination of medications are required, so the cost of treatment is more expensive. Second, there must be an appropriate "timing" for the use of antiviral drugs. Studies have shown that antiviral treatment is more effective when the patient's inflammatory activity is more obvious (that is, the ALT increase is more obvious). For adolescent patients due to mother-to-child transmission, While ALT is normal (called immune tolerance), currently commonly used drugs cannot break "immune tolerance", so the efficacy is not good. For patients who are currently unable to take antiviral drugs, the following points should be noted: (1) Avoid alcohol, prevent overwork, etc. (2) For those with only mild ALT elevation, give liver protection and enzyme-lowering drugs, and use anti-fibrosis drugs if necessary Drugs to prevent long-term and repeated accumulation of mild inflammation to form liver fibrosis and cirrhosis, and wait for the opportunity for antiviral treatment. 6 (3) Regularly check liver function, B-ultrasound and hepatitis B virus markers ("two and a half") to grasp the condition in time and grasp the opportunity for treatment. (4) For teenagers with "big three yang" and normal ALT, you can try: dipyridamole (dipyridamole) orally, 50 mg each time, 2 times a day, plus hepatitis B genetic engineering vaccine 10 μg intramuscular injection, every 2 1 time a week. Levamisole coating agent is applied externally to the inner thigh, twice a week, and the treatment course is at least 6 months. This method is cheap and may have certain effects on some patients. The pathological basis of severe hepatitis is that liver cells fall into liver failure due to massive or sub-large necrosis caused by various reasons. The prognosis mainly depends on the number of surviving liver cells. Therefore, monitoring and treatment must be carried out at an early stage when there are still a considerable number of viable liver cells to gain time for liver cell regeneration. Early diagnosis and early treatment are required. The treatment principles are: supportive treatment to protect the physiological and metabolic functions of the whole body; prevention and treatment of serious complications; for patients who are expected to be difficult to recover with supportive treatment, artificial liver support systems should be applied as early as possible to create conditions for liver transplantation.
(1) Supportive treatment 1) Treatment should be carried out in the intensive care unit, and vital functions should be closely monitored, such as cardiopulmonary function, serum electrolytes, arterial blood gas analysis, prothrombin time, blood sugar, serum aminotransferase, bilirubin, etc. as the main monitoring indicators. Intravenous intubation was performed, and urinary and gastric tubes were placed. Strict disinfection and isolation to prevent nosocomial infections; 2) Infusion of fresh plasma, whole blood or albumin every day or every 2-3 days as appropriate is one of the main contents of basic comprehensive treatment (fresh plasma or whole blood can supplement coagulation factors and improve opsonin levels, which is helpful in preventing bleeding and secondary infection); 3) high-sugar, high-vitamin diet, intravenous infusion of fat emulsion and branched-chain amino acids to supplement calories and correct hypoglycemia; 4) replenish electrolytes and correct acid-base balance imbalance, Such as correcting hyponatremia, hypokalemia, respiratory acidosis, and metabolic alkalosis. (2) Timely detect and treat serious complications, such as cerebral edema, infection, renal failure, gastrointestinal bleeding, etc. (3) Application of artificial liver support system. (4) Commonly used drugs: Early use of prostaglandin E1, hepatocyte growth factor, and immunomodulatory agent thymosin α1 (Ridaxian) are effective in treating severe hepatitis. (5) Treatment of severe hepatitis-complicated infections. Due to low immune function and severe liver damage, severe hepatitis-complicated infections are often difficult to control, and most of them are nosocomial infections, often with drug-resistant strains, making treatment more difficult. To this end, we should pay attention to the following points: 1) Early detection and early treatment to minimize the adverse effects of infection. 2) Antibiotics should be used early, in appropriate amounts, and the course of treatment should be long enough. Because infections are more serious and often nosocomial infections. It is advisable to choose powerful antibiotics, such as third-generation cephalosporins, quinolones, Imipenem (Imipenem), Sulperazon (Cefoperazone plus Sulbactam), etc., and of course Antibiotics should be selected based on bacterial culture and drug susceptibility testing, the nature, location and scope of infection, and economic conditions. Pay attention to anaerobic bacteria or mixed infections, and use metronidazole if necessary. For fungal infections, nystatin, miconazole, fluconazole, etc. can be used. 3) Actively adopt supportive therapy and supplement appropriate amounts of fresh blood, plasma or albumin. 4) Pay attention to basic care and disinfection and isolation. The ward is disinfected with 2% peracetic acid, ultraviolet light, etc. every day, and the patient rinses his mouth with mouthwash once a day. What is the effect of hepatocyte growth factor, prostaglandin E1, and glucagon-insulin in treating severe hepatitis? Hepatocyte growth factor (HSS) is a polypeptide extracted from the liver of suckling pigs or cows. It can promote the synthesis of DNA in liver cells, promote the regeneration of liver cells, block free radical lipid peroxidation, inhibit tumor necrosis factor, and prevent Hepatocyte necrosis can also enhance the function of Kupffer cells. Usage: For chronic hepatitis, intramuscular injection of HSS 20 mg per time, 1-2 times a day, for 2-3 months; for severe hepatitis, use HSS 80-100 mg plus 10% glucose for intravenous infusion of 250 ml, and the course of treatment depends on the condition. . Individual patients may develop fever and occasionally rash. Prostaglandin E1 (PGE1) has a protective effect on liver cells. It can promote the synthesis of prealbumin and albumin, be choleretic and reduce jaundice, be a diuretic, eliminate ascites and edema, dilate blood vessels, inhibit platelet aggregation and disseminated intravascular coagulation, and inhibit And remove immune complexes, protect gastric mucosa, and prevent ulcer bleeding. Usage: Add PGE1100-200 micrograms to 500 ml of 10% glucose solution for intravenous infusion, once a day or every other day, 5 times as a course of treatment. Adverse reactions include: fever, headache, abdominal distension, numbness of the tongue, vomiting, and diarrhea within 4-8 hours of taking the drug. The reaction is obvious after the first dose, and will lessen as the frequency of medication increases. Phlebitis may occur with long-term use. Glucagon-insulin therapy (G-I therapy) can prevent liver necrosis and promote liver cell regeneration, improve amino acid metabolism disorders, reduce blood ammonia and blood aromatic amino acid concentrations, improve hepatic encephalopathy, and promote protein synthesis. It is used for The curative effect is better for acute severe hepatitis. Since glucagon can increase blood flow in the esophageal veins, caution should be used when using this therapy to treat chronic severe hepatitis, especially patients who have experienced upper gastrointestinal bleeding and high-grade esophageal varices. However, some scholars hold different views on GI therapy, so the efficacy of GI therapy in treating severe hepatitis needs further clinical verification.
Usage: Glucagon 1 mg and regular insulin 10 units are added to 250-500 ml of 10% glucose and infused slowly intravenously (it takes 3-4 hours), 1-2 times a day, 2 weeks as a course of treatment, at the same time Intravenous infusion of compound amino acids can help improve and maintain the ratio of branched-chain amino acids and aromatic amino acids. Adverse reactions include gastrointestinal reactions, and attention should be paid to the occurrence of hypoglycemia and hypokalemia.