Abstract: OBJECTIVE To study the efficacy and safety of acarbose combined with ornithine aspartate in patients with hepatic encephalopathy. METHODS Seventy-six patients with cirrhosis and hepatic encephalopathy were randomly divided into observation group and control group (38 cases in each group). On the basis of routine treatment, patients in the control group were treated with ornithine aspartate, while patients in the observation group were treated with acarbose combined with ornithine aspartate. Before and after treatment, the levels of aspartate aminotransferase (AST), alanine pathological transferase (ALT), alkaline phosphatase (ALP), serum total bilirubin (TBIL) and total protein (TP) levels were measured by automatic biochemical analyzer. The level of blood ammonia was measured with blood ammonia analyzer. The level of plasma endotoxin was determined with chromogenic matrix technetium kit and spectrophotometer. The cognitive status of the patients was evaluated using the Mini-Mental State Examination Scale (MMSE) and the Modified Hasegawa Dementia Scale (HDS-R). Neuropsychological testing was performed using NCT-A. The metabolites levels of the brain was measured, such as choline, alcohol (mI), glutamine complex (Glx) and N-aspartic acid (NAA). Observe and record the occurrence of adverse reactions during the treatment. RESULTS After treatment, the total effective rate of the observation group was significantly higher than the aspartate ornithine alone group (89.47% vs 71.05%, P<0.05). The levels of AST, ALT, TBIL, blood ammonia and endotoxin in the observation group were significantly lower than those before treatment and the control group (P<0.05). ALP and TP levels were significantly higher in the observation group than before treatment and the control group (P<0.05). The MMSE and HDS-R scores in the observation group were significantly higher than those in the control group (P<0.05), and the NCT time was significantly lower than that in the control group (P<0.05). Observed group mI/Cr and Cho/Cr were significantly higher than before treatment and control group (P<0.05), Glx/Cr was significantly lower than that before treatment and control group (P<0.05). CONCLUSION Acarbose combine with ornithine aspartate can effectively reduce blood ammonia and endotoxin, improve the symptoms of hepatic encephalopathy, and play a role in protecting the liver, show the brain protection and the improvement of life quality of patients.