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간성 뇌중 환자에서 Flumazenil 의 효과 및 안정성에 관한 전향성 연구
추원석(Won Seok Choo),최호열(Ho Yul Choi),빈중선(Joong Sun Bin),최예원(Rye Won Choi),전용철(Yong Cheol Jeon),김학양(Hak Yang Kim),박충기(Choong Kee Park),유재영(Jae Young Yoo),이병철(Byung Chul Lee) 대한내과학회 1994 대한내과학회지 Vol.46 No.4
N/A Objectivea: Ther are still many controversies on the pathogenesis of the hepatic encephalopathy. Recently, it has been postulated that endogenous benzodiazepine like substance (s) may be involved in the neuroinhibitory effect of gamma-aminobutyric acid (GABA). For this reason, benzodiazepine antagonist, flumazenil, has been advocated as a new treatment for hepatic encephalopathy. Several studies reported clinical improvement of hepatic encephalopathy in patients treated with flumazenil but these were not controlled studies. Methods: To investigate the effect of flumazenil, we performed a double-blind, prospective study in the 13 patients with hepatic encephalopathy who fulfilled the inclusion criteria of the protocol. The drug was administered intravenously (flumazenil 2.2 mg bolus injection followed by a continuous infusion with a rate of 1 mg/ h or placebo) in coded vial. After the code was open, 6 patients received flumazenil and the other 7 palcebo. The ages were 36 to 61(mean 54) years and 7 were male and 6 female. The causes of liver cirrhosis were HBV related in 7, HCV related in 3, and 3 were alcoholics. Results: In the fumazenil group, 4(67%) demonstrated immediate improvement of mental state with various degrees (from stage III to II in 1 and from stage I & II to 0 in 3). The significant and immediate improvement in the electroencephalographic (EEG) findings were noted in 3(50%), In the placebo group, however, 2(29%) showed an immediate improvement in EEG findings but only one (14%) showed the immediate improvement of mental status. There was no evidence of significant adverse reaction related to the treatment. Conclusion: This study shows that the benzodiazepine antagonist flumazenil may be effective and safe in patients with hepatic encephalopathy in the immediate mangement. Long term beneficial effect may be expected by treating the patients with more convinient oral administration.
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