左乙拉西坦预防小儿热性惊厥复发的临床研究

发布时间：2018-03-30 06:10

  本文选题：热性惊厥　切入点：预防　出处：《吉林大学》2012年硕士论文

【摘要】：背景与目的：FS是小儿惊厥最常见的原因，复发率高，且癫痫发生率远远高于一般人群。目前主要通过间断应用DZP和长期口服VPA或PB来预防复发，有效率为70～80%，但这些药物的不良反应明显，甚至超过了治疗作用。LEV为新型AED，作用机制独特，起效迅速，有良好的抗癫痫疗效和安全性。近年来动物试验研究表明LEV预防FS复发的有效性与VPA、PB相似，且副作用小。本研究旨在评价该药在预防FS复发方面的临床有效性与安全性，并与空白对照组比较，为FS的复发用药提供新选择。 方法：收集2010年9月～2012年2月就诊于吉林大学第一医院小儿神经科的FS患儿81例，经监护人同意后，行血电解质、肝肾功能、血常规、尿常规和24小时动态脑电图(24-hour ambulatory electroencephalogram，24hAEEG)等检查。随机分为对照组、低剂量组、高剂量组三组，体温超过37.5℃时对照组仅口服退热药，治疗组分别口服左乙拉西坦片20mg/(kg·d)、40mg/(kg·d)，，连续口服5天后停药，同时体温超过38.5℃时口服退热药。每3个月随访1次，记录发热次数、FS复发次数、服药情况、药物不良反应，每半年复查24hAEEG1次，共随访1年～1年半。若出现2次无热惊厥或1次无热惊厥伴24hAEEG癫痫样放电则诊断为癫痫。 结果：(1)FS复发情况对比：对照组、低剂量组及高剂量组入组患儿分别为27例、28例、26例，三组复发例数分别为13例、5例、4例，复发率分别为48.1%、17.9%、15.4%，平均复发次数分别为2.38±0.48次、1.60±0.54次、1.50±0.50次，对照组与两个治疗组比较差异均有统计学意义，高、低剂量组间比较差异无统计学意义。SFS和CFS复发率在低、高剂量组间对比差异无统计学意义。(2)癫痫发生率对比：对照组、低剂量组、高剂量组分别有2例、1例、1例诊断为癫痫，发生率各为7.4%、3.6%、3.8%，对照组发生率高于治疗组，但组间两两对比差异均无显著性。(3)不良反应：低剂量组仅1例出现轻度兴奋，高剂量组出现兴奋、冲动各2例，嗜睡、头晕各1例，不良反应发生率分别为3.6%、23.1%，两组间对比差异有显著性。 结论：(1) LEV可以有效预防小儿FS复发。(2)LEV不能降低FS患儿的癫痫发生率。(3)观察过程中高剂量组不良反应发生率高于低剂量组，但均未出现严重副反应。
[Abstract]:Background and objective: FS is the most common cause of infantile convulsion. The recurrence rate is high and the incidence of epilepsy is much higher than that of the general population. At present, recurrent seizures are mainly prevented by intermittent use of DZP and long-term oral administration of VPA or PB. The effective rate was 70% and 80%, but the adverse effects of these drugs were obvious, even more than the therapeutic effect. LEV was a new type of AED.The mechanism of action was unique and the effect was rapid. It has good antiepileptic efficacy and safety. In recent years, animal studies have shown that the efficacy of LEV in preventing the recurrence of FS is similar to that of VPAP, and the side effects are small. The purpose of this study was to evaluate the clinical efficacy and safety of LEV in preventing the recurrence of FS. Compared with the blank control group, it provides a new choice for the recurrence of FS. Methods: from September 2010 to February 2012, 81 patients with FS in the Department of Pediatric Neurology, first Hospital of Jilin University, were collected. Blood electrolytes, liver and kidney function, blood routine examination were performed with the consent of guardian. Urine routine and 24 hour ambulatory electroencephaloencephaloencephalogram (AEGG) were randomly divided into three groups: control group, low dose group, high dose group, and the control group only took antipyretic when body temperature was over 37. 5 鈩

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