First, the cause of disease
The occurrence of hepatic encephalopathy is closely related to liver failure. The common factors leading to liver failure in patients with liver cancer include advanced diffuse liver cancer and a large number of liver cancer cells, extensive infiltration of cancer cells or cirrhosis, obvious damage of liver function, or modern anti-tumor treatments such as hepatic artery ligation, hepatic artery embolization chemotherapy and radiotherapy.
Second, diagnosis.
Hepatic encephalopathy is a complication of liver cancer, and its diagnosis is not difficult. The following points can be used as the basis for diagnosis: 1. Patients with advanced liver cancer will have a series of signs of mental and neurological abnormalities, such as consciousness change, sleep error, flapping wing tremor and coma.
2, can be caused by upper gastrointestinal bleeding, liver cancer rupture bleeding, secondary infection, ascites, the use of large doses of diuretics. It is caused by surgical trauma, the use of drugs that damage the liver and a high-protein diet.
3. Patients with decompensated cirrhosis have obvious incentives to have the above symptoms.
4. The blood ammonia is higher than 59 μ mol/L. 。
5, EEG has obvious abnormal changes, such as slow rhythm, beta wave, bilateral symmetrical high pressure slow wave. Digital connection, digital marking test, building block test and signature test are all helpful for early diagnosis.
Third, clinical manifestations
On the basis of the common symptoms of liver cancer, such as mass in the upper abdomen, pain in the liver area, emaciation, loss of appetite, etc., the main manifestations are mental trance, decreased ability of orientation and calculation, and drowsiness. Coma and flapping flutter, etc. Flutter tremor is a characteristic manifestation of hepatic encephalopathy. 1983 The Chinese Medical Association classifies hepatic encephalopathy into the following three levels:
Grade I: slow response, inattention, insomnia, euphoria, personality change, lack of response to surrounding things, abnormal behavior, depression, lethargy and disorientation.
Grade II: insanity, denial, stupor, lethargy, flapping flutter or involuntary movement.
Grade ⅲ: coma, including deep coma and shallow coma.
The first level is often ignored and the second level is valued. EEG is helpful for diagnosis.
Fourth, treatment.
Once liver cancer is complicated with hepatic encephalopathy, the prognosis is poor, and there are few reports of successful rescue. Early detection, early diagnosis and early treatment should be emphasized.
(1) Treatment of tumor Patients with liver cancer who usually have hepatic encephalopathy rarely use "aggressive treatment" for tumors, such as surgery, radiotherapy, chemotherapy, etc.
(2) To remove the inducement, we should actively prevent infection and gastrointestinal bleeding, avoid using a large number of diuretics and discharging ascites, prohibit anesthetics and sedatives (such as morphine), and correct the imbalance of water and electrolyte in time; Substances containing ammonia, such as ammonium chloride, are prohibited. Hydrolyzed protein, acesulfame K and other drugs that increase blood ammonia.
(3) Nutrition and diet limit people's intake of protein. It is best to choose vegetable protein. When the condition is serious, a protein-free diet should be adopted. And ensure adequate calories and vitamins, including vitamins A, B, C, D and K and folic acid. Patients who can't eat should be given nasal feeding or intravenous supplementation.
(4) Symptomatic treatment 1, and ice pillow or ice cap can be used to protect brain cells. 2, to prevent brain edema can be dehydrated with mannitol.
3. Correct water, electrolyte and acid-base balance.
(5) The names of treating anhepatic encephalopathy in TCM can be divided into coma, coma and madness. There is a difference between reality and reality. What is real is mostly turbid. Blood stasis. Damp-heat is caused by blinding the gods and belongs to the category of closed syndrome; Deficiency is mostly caused by deficiency of qi and blood, yin and yang failure, etc. , leading to loss of nutrition and mental dependence, which belongs to the category of syndrome differentiation; However, most patients are mixed with excess and deficiency, and deficiency is real. Over the years, Chinese medicine has accumulated a lot of experience in treating this disease.
(1) The main symptoms of blinding dampness and heat are: dull or yellow complexion, abdominal distension or fullness, tightness in the abdomen, loss of appetite, gradually blurred consciousness, unclear language, unconsciousness, phlegm in the pharynx, nausea and vomiting, or accompanied by upset, body heat at night, bitter taste and dry mouth, astringent Huang Chi, defecation or filth, red or red tongue. Treatment: clearing away heat and toxic materials, resolving phlegm and inducing resuscitation. Prescription: Qingqi Huatan Pill. Commonly used drugs: Herba Artemisiae Scopariae, Radix et Rhizoma Rhei, Rhizoma Pinelliae, Rhizoma Arisaematis, Fructus Citri Grandis, Caulis Bambusae, Fructus Aurantii Immaturus, Fructus Cucurbitae Moschatae, Herba Hedyotidis Diffusae, Herba Scutellariae Barbatae and Herba Hedyotidis Diffusae. For those with yellow urine, fever, dry mouth and bitter taste, the dosage of Herba Artemisiae Scopariae and Radix et Rhizoma Rhei can be increased, and Herba Lysimachiae Christinae, Radix Platycladi, Antelope and Radix Bupleuri can be added as appropriate. For patients with melena or hematemesis, Rhizoma Imperatae, Herba et Gemma Agrimoniae, Radix Notoginseng, Folium Platycladi and Radix Sangusorbae can be added, or Yunnan Baiyao can be added. Plantain seed, cogongrass rhizome, Alisma orientale, etc. Short and red urine and edema of limbs can be added. If the abdomen is as big as a drum, Pericarpium Arecae, Alismatis Rhizoma, Polyporus, Semen Plantaginis, Dictyophora and Stigma Maydis can be added as appropriate.
(2) The main symptoms of phlegm and turbidity: dull or dull complexion, loss of appetite, chest tightness, abdominal distension or bloating, unclear language, unconsciousness, nausea and vomiting, long urination, loose stool, or accompanied by wheezing, phlegm in the pharynx, or cold limbs, dull and tender tongue, teeth marks on the edge, white greasy or gray-black tongue coating, and heavy and slippery pulse. Treatment: Yiqi Quji, turbidity and resuscitation. Prescription: Ditan Decoction. Commonly used drugs: Pinellia ternata, Arisaema, Pericarpium Citri Reticulatae, Radix Cynanchi, Radix Curcumae, Poria, Rhizoma Zingiberis Recens, Cortex Magnolia Officinalis and Ginseng. Pogostemon cablin, atractylodes rhizome, etc. For those with melena and hematemesis, Radix Astragali, Rhizoma Bletillae and cuttlefish bone can be added. For those with dyspnea and phlegm in the throat, leather pants, perilla seeds, Inula flowers and other products can be added to reduce qi and relieve asthma. For those with cold limbs, add aconite, cinnamon, dried ginger and other pungent and cold-dispelling products.