甲泼尼龙冲击疗法联合抗癫痫药物治疗儿童睡眠期癫痫性电持续状态效果观察

发布时间：2018-04-24 16:46

本文选题：甲泼尼龙 + 抗癫痫药物　；参考：《山东医药》2017年02期

【摘要】：目的观察甲泼尼龙冲击疗法联合抗癫痫药物治疗儿童睡眠期癫痫性电持续状态(ESES)的临床效果。方法将67例ESES患儿随机分为观察组34例和对照组33例。对照组给予奥卡西平口服,起始剂量6~8 mg/(kg·d),维持剂量25~30 mg/(kg·d),2次/d,4 d为1个疗程,连续治疗3个疗程。观察组在对照组基础上给予甲泼尼龙冲击治疗,剂量为15~20 mg/(kg·d),连续3 d,每周1个疗程,连续3个疗程;其后给予泼尼龙1.5~2.0mg/(kg·d),根据患儿病情减量,维持治疗3~6个月。结果治疗前,两组言语智商、操作智商、韦氏儿童智力量表总分比较差异均无统计学意义(P均0.05);治疗6个月后,两组言语智商(类同)、操作智商(填图)、韦氏儿童智力量表总分均较治疗前提高(P均0.05),且观察组高于对照组(P均0.05)。治疗6个月后,观察组脑电图治疗显效率为50.00%,显著高于对照组的27.27%(P0.05);观察组临床显效率26.47%,高于对照组的12.12%(P0.05)。治疗过程中,观察组出现感染4例、体质量增加和库欣综合征27例、低血钾2例,治疗结束停药后上述不良反应症状逐渐消失;对照组未见明显的不良反应。结论甲泼尼龙冲击疗法联合抗癫痫药物治疗儿童ESES的临床效果较好,能显著改善患儿认知功能,但皮质激素引起的不良反应发生率较高。
[Abstract]:Objective to observe the clinical effect of methylprednisolone pulse therapy combined with antiepileptic drugs in the treatment of ESES during sleep in children. Methods 67 children with ESES were randomly divided into observation group (n = 34) and control group (n = 33). The control group was given oxcarbazepine orally at an initial dose of 68 mg/(kg / d and a maintenance dose of 2530 mg/(kg / d / d for one course of treatment for 3 consecutive courses. The observation group was treated with methylprednisolone impact therapy on the basis of control group, the dosage was 15 ~ 20 mg/(kg / d for 3 consecutive days, one course of treatment per week for 3 consecutive courses, and then the treatment was maintained for 3 ~ 6 months according to the reduction of the patient's condition. Results before treatment, there were no significant differences in verbal intelligence quotient, operational intelligence quotient and total score of Wechsler intelligence scale between the two groups (P < 0.05). The verbal intelligence quotient (LIQ) of the two groups (similar to that of the control group), the total score of Wechsler children's intelligence scale (WIQ) were all higher than those before treatment (P 0.05), and that of the observation group was higher than that of the control group (P < 0.05). After 6 months of treatment, the effective rate of electroencephalogram in the observation group was 50.005, which was significantly higher than that in the control group (27.27), and the clinical effective rate in the observation group was 26.47, which was higher than that in the control group (12.12) (P0.05). During the course of treatment, 4 cases of infection, 27 cases of Cushing's syndrome and 2 cases of hypokalemia were found in the observation group, but the adverse reaction symptoms disappeared gradually after the end of the treatment, but there was no obvious adverse reaction in the control group. Conclusion methylprednisolone pulse therapy combined with antiepileptic drugs is effective in the treatment of children with ESES, and can significantly improve cognitive function of children, but the incidence of adverse reactions caused by corticosteroids is higher.
【作者单位】：河源市人民医院;
【分类号】：R742.1

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