FEATURES OF THE ESTIMATION OF THE HEPATIC ENCEPHALOPATHY IN PATIENTS WITH LIVER CIRRHOSIS

Аннотация

Purpose. To determine the features of assessing the severity of hepatic encephalopathy in patients with liver cirrhosis. Material and methods. The study included 490 patients with liver cirrhosis. The criterion for assessing the severity of hepatic encephalopathy at the stages of portosystemic shunting was the results of determining the critical flicker frequency obtained using the HEPAtonormTM-Analyzer. All patients were operated on in a planned manner: selective shunting (distal splenorenal anastomosis) - 306 (62.4%); central - 184 (37.6%): proximal splenorenal anastomosis with splenectomy - 13 (2.7%); latero-lateral splenorenal anastomosis - 62 (12.7%); splenosuprarenal anastomosis - 84 (17.1%); H-splenorenal anastomosis - 25 (5.1%). Results. In 100.0% of cases, portosystemic shunting worsens the rate of critical flicker (from 39.5 ± 0.9 to 37.8 ± 1.2 Hz, P <0.001), and if before the operation, hepatic encephalopathy was absent or was in latent form in 76.3% of patients, already in the early stages after the intervention, this figure decreased to 46.7%, and the majority of patients had clinically significant signs of hepatic encephalopathy. Against the background of postoperative conservative therapy, the tendency to improve the level of the critical flicker rate was more pronounced after selective portosystemic shunting (39.5 ± 1.1 Hz), whereas in the group of patients with central decompression the rate of critical flicker improves with less intensity, reaching discharge moment is only 38.3 ± 1.2 Hz (P <0.001). Conclusions. The level of the critical flicker frequency when planning for system-bypass shunting is of fundamental importance, which leads to a high probability of the development of postoperative severe liver failure with initially low rates.