Eficacia de lactulosa sola y con rifaximina en encefalopatía hepática según resultados clínicos y laboratorio
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2021
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
La encefalopatía hepática se asocia con un mal pronóstico en la cirrosis. Los
medicamentos utilizados en su tratamiento se dirigen principalmente a prevenir y
revertir el grado de encefalopatía. La rifaximina y la lactulosa han demostrado ser
efectivas en esta enfermedad. Objetivo: Determinar la eficacia de lactulosa sola y
con rifaximina en encefalopatía hepática según resultados clínicos y laboratorio.
Metodología: Se realizó un estudio analítico, observacional, retrospectivo y
aplicativo, en el Hospital de Especialidades Abel Gilbert Pontón durante el periodo
2017-2020, con una muestra de 80 pacientes con encefalopatía hepática, divididos
en dos grupos: grupo A (lactulosa sola; n= 40) y grupo B (lactulosa + rifaximina
1.100 mg/día; n= 40). Resultados: La mayoría de los pacientes eran de sexo
masculino (52.5%) y con más de 60 años (57.5%), al ingreso con encefalopatía
hepática grado 3 (71.3%), Child Pugh Tipo B (73.8%) y grado de amonio 3 entre
151-200 umol/L (37.5%). Los pacientes que recibieron Rifaximina + Lactulosa
tuvieron remisión de encefalopatía n=25 (80.6%) Vs grupo de lactulosa sola n=6
(19.4%) p <0.05, IC 95%. Se registraron niveles de amonio más bajos grado 0 n=15
(65.2%), el análisis de complicaciones y mortalidad no revelaron significancia
estadística entre los 2 grupos, no se registraron efectos adversos y tuvieron menor
estancia hospitalaria (5.5 días). Conclusión: La combinación de lactulosa más
rifaximina es más efectiva que la lactulosa sola en el tratamiento de la encefalopatía
hepática manifiesta en cuanto a mejoría clínica, disminución de niveles de amonio,
menos efectos adversos y menor estancia hospitalaria.
Hepatic encephalopathy is associated with a poor prognosis in cirrhosis. The drugs used in its treatment are mainly aimed at preventing and reversing the degree of encephalopathy. Rifaximin and lactulose have been shown to be effective in this disease. Objective: To determine the efficacy of lactulose alone and with rifaximin in hepatic encephalopathy according to clinical and laboratory results. Methodology: An analytical, observational, retrospective and applicative study was carried out at the Abel Gilbert Pontón Specialties Hospital during the period 2017- 2020, with a sample of 80 patients with hepatic encephalopathy, divided into two groups: group A (lactulose alone; n = 40) and group B (lactulose + rifaximin 1,100 mg / day; n = 40). Results: Most of the patients were male (52.5%) and over 60 years old (57.5%), upon admission with hepatic encephalopathy grade 3 (71.3%), Child Pugh Type B (73.8%) and grade of ammonium 3 between 151-200 umol / L (37.5%). Patients who received Rifaximin + Lactulose had remission of encephalopathy n = 25 (80.6%) Vs lactulose alone group n = 6 (19.4%) p <0.05, 95% CI. Lower grade 0 ammonia levels were recorded n = 15 (65.2%), the analysis of complications and mortality did not reveal statistical significance between the 2 groups, no adverse effects were recorded and they had a shorter hospital stay (5.5 days). Conclusion: The combination of lactulose plus rifaximin is more effective than lactulose alone in the treatment of manifest hepatic encephalopathy in terms of clinical improvement, decreased ammonium levels, fewer adverse effects and shorter hospital stay.
Hepatic encephalopathy is associated with a poor prognosis in cirrhosis. The drugs used in its treatment are mainly aimed at preventing and reversing the degree of encephalopathy. Rifaximin and lactulose have been shown to be effective in this disease. Objective: To determine the efficacy of lactulose alone and with rifaximin in hepatic encephalopathy according to clinical and laboratory results. Methodology: An analytical, observational, retrospective and applicative study was carried out at the Abel Gilbert Pontón Specialties Hospital during the period 2017- 2020, with a sample of 80 patients with hepatic encephalopathy, divided into two groups: group A (lactulose alone; n = 40) and group B (lactulose + rifaximin 1,100 mg / day; n = 40). Results: Most of the patients were male (52.5%) and over 60 years old (57.5%), upon admission with hepatic encephalopathy grade 3 (71.3%), Child Pugh Type B (73.8%) and grade of ammonium 3 between 151-200 umol / L (37.5%). Patients who received Rifaximin + Lactulose had remission of encephalopathy n = 25 (80.6%) Vs lactulose alone group n = 6 (19.4%) p <0.05, 95% CI. Lower grade 0 ammonia levels were recorded n = 15 (65.2%), the analysis of complications and mortality did not reveal statistical significance between the 2 groups, no adverse effects were recorded and they had a shorter hospital stay (5.5 days). Conclusion: The combination of lactulose plus rifaximin is more effective than lactulose alone in the treatment of manifest hepatic encephalopathy in terms of clinical improvement, decreased ammonium levels, fewer adverse effects and shorter hospital stay.
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Lactulosa, Encefalopatía hepática, Rifaximina, Cirrosis hepática, Diagnóstico clínico, Técnicas de laboratorio clínico, Epidemiología analítica, Estudios retrospectivos, Hospital de Especialidades Guayaquil Dr. Abel Gilbert Pontón, Cantón Guayaquil, Ecuador