目的 探讨双歧杆菌四联活菌片联合注射用门冬氨酸鸟氨酸治疗肝性脑病的临床疗效。方法 选取2014年4月-2016年2月恩施州中心医院收治的肝性脑病患者96例为研究对象，将患者随机分为对照组和治疗组，每组各48例。对照组静脉滴注注射用门冬氨酸鸟氨酸，10 g注射用门冬氨酸鸟氨酸加入到5%葡萄糖注射液或0.9%氯化钠注射液250 mL中溶解，1次/d。治疗组在对照组基础上口服双歧杆菌四联活菌片，3片/次，3次/d。两组患者均连续治疗10 d。观察两组临床疗效，比较治疗前后两组认知功能指标、肝功能、血氨指标、内毒素和炎症因子指标。结果 治疗后，对照组和治疗组的总有效率分别为79.17%、93.75%，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者数字连接实验（NCT）时间显著减少，数字符号试验（DST）评分显著增高，同组治疗前后比较差异具有统计学意义（P<0.05）。治疗后，治疗组认知功能指标显著优于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者的血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBiL）和血氨水平均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）。治疗后，治疗组肝功能和血氨指标水平显著低于对照组，两组比较差异具有统计学意义（P<0.05）。治疗后，两组患者的内毒素（LPS）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-18（IL-18）水平均显著降低，同组治疗前后比较差异具有统计学意义（P<0.05）。治疗后，治疗组内毒素和炎症因子指标水平显著低于对照组，两组比较差异具有统计学意义（P<0.05）。结论 双歧杆菌四联活菌片联合注射用门冬氨酸鸟氨酸治疗肝性脑病具有较好的临床疗效，能够明显改善患者的认知状态和肝功能，降低血氨、内毒素和炎症因子水平，且安全性较好，具有一定的临床推广价值。

Objective To investigate the clinical effects of Combined Bifidobacterium, Lactobacillus, Enterococcus and Bacillus Tablets combined with Ornithine Aspartate for injection in treatment of hepatic encephalopathy. Methods Patients (96 cases) with hepatic encephalopathy in Enshi Central Hospital from April 2014 to February 2016 were randomly divided into control group and treatment group, and each group had 48 cases. Patients in the control group were iv administered with Ornithine Aspartate for injection, 10 g Ornithine Aspartate for injection added into 250 mL 5% glucose injection or 0.9% NaCl injection, once daily. Patients in the treatment group were po administered with Combined Bifidobacterium, Lactobacillus, Enterococcus and Bacillus Tablets on the basis of the control group, 3 tablets/time, three times daily. Patients in two groups were treated for 10 d. After treatment, the clinical efficacy was evaluated, and the cognitive function indicators, liver function, blood ammonia indexes, endotoxin, and inflammatory factors in two groups before and after treatment were compared. Results After treatment, the clinical efficacies in the control and treatment groups were 79.17% and 93.75%, respectively, and there was difference between two groups (P<0.05). After treatment, NCT times in two groups were significantly decreased, but DST scores in two groups were significantly increased, and the difference was statistically significant in the same group (P<0.05). After treatment, the cognitive function indicators in the treatment group were significantly better than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of ALT, AST, TBiL, and blood ammonia in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). After treatment, the liver function and blood ammonia levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). After treatment, the levels of LPS, TNF-α, IL-6, and IL-18 in two groups were significantly decreased, and the difference was statistically significant in the same group (P<0.05). After treatment, the LPS and inflammatory factors levels in the treatment group were significantly lower than those in the control group, with significant difference between two groups (P<0.05). Conclusion Combined Bifidobacterium, Lactobacillus, Enterococcus and Bacillus Tablets combined with Ornithine Aspartate for Injection has clinical curative effect in treatment of hepatic encephalopathy, can significantly improve the cognitive function indicators and liver function, reduce the levels of blood ammonia, LPS, and inflammatory factors, with good safety, which has a certain clinical application value.