左乙拉西坦与苯妥英钠预防颅脑损伤患者痫性发作疗效荟萃分析

发布时间：2018-03-16 09:41

本文选题：LEV　切入点：PHT　出处：《重庆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:系统评价左乙拉西坦(LEV)与苯妥英钠(PHT)预防颅脑损伤后痫性发作的疗效、药物副作用及死亡率等。方法:通过关键词PHT、LEV、颅脑损伤在Pubmed、Medline、Ovid、Springer、中国知网、万方等数据库,收集2000至2016年来国内外针对LEV和PHT预防颅脑损伤后痫性发作的疗效对比的高质量研究,通过严格的纳入和排除标准,提取有效数据并利用Rev Man5.3软件进行荟萃分析。结果:经文献检索、筛选后共纳入13篇英文研究,共包含2529例患者。荟萃分析结果显示:LEV组对比PHT组对痫性发作预防用药效果评价上,差异没有统计学意义(RR=0.88,95%CI[0.61,1.27]);对早期痫性发作预防用药效果评价上,差异没有统计学意义(RR=0.74,95%CI[0.42,1.27]);对晚期癫痫预防用药效果评价上,差异没有统计学意义(RR=0.71,95%CI[0.43,1.20]);两药对比在药物副作用的人数上,差异没有统计学意义(RR=0.73,95%CI[0.48,1.11]),但在因药物副作用需要停药或改变治疗方案的患者,PHT组多于LEV组,差异有统计学意义(RR=0.11,95%CI[0.06,0.23]);在预防用药对死亡率的比较分析中,差异没有统计学意义(RR=1.57,95%CI[0.92,2.67]);在住院时间长短上两者差异无统计学意义(WMD=-1.03,95%CI[-4.97,2.91])。结论:LEV和PHT在颅脑损伤后痫性发作的预防上有同等效力;在药物副作用的人数、死亡率及住院时间方面,LEV与PHT相比没有优势。但在因药物副作用而需要停药或改变治疗方案的患者,PHT组多于LEV组,差异有统计学意义。根据目前的证据分析得出PHT仍是颅脑损伤患者药物的首选,但当其出现不可耐受的药物副作用及药物相互作用时,LEV是一个很好的替代治疗。由于本荟萃分析纳入的高质量的随机对照试验(RCT)较少,有必要针对两药开展前瞻性、大样本、多中心、跨种族人群的高质量研究。
[Abstract]:Objective: to evaluate the efficacy, side effects and mortality of levoethoxetam and phenytoin sodium (PHT) in the prevention of epileptic seizures after craniocerebral injury. From 2000 to 2016, high quality studies on the efficacy of LEV and PHT in preventing epileptic seizures after craniocerebral injury were collected, and the criteria were strictly included and excluded. Effective data were extracted and meta-analysis was carried out using Rev Man5.3 software. Results: after literature retrieval, 13 English studies were included. The results of meta-analysis showed that there was no significant difference between the two groups in evaluating the effect of prophylactic drugs on epileptic seizures compared with the PHT group, and there was no significant difference between the two groups in evaluating the efficacy of prophylactic drugs for early epileptic seizures. The difference was not statistically significant (P < 0.05). There was no significant difference in the evaluation of the efficacy of prophylactic medication for advanced epilepsy. There was no significant difference between the two drugs in the evaluation of the efficacy of prophylactic medication for advanced epilepsy, and there was no significant difference in CI (0.43 卤1.20). The two drugs were compared in the number of side effects. The difference was not statistically significant (P < 0. 481.11), but there were more patients in LEV group than in LEV group, and the difference was statistically significant (P < 0. 06). There was no significant difference in RRX 1.5795 CI [0.922.67], but there was no significant difference in the length of hospitalization between the two groups. Conclusion the two groups have the same efficacy in the prevention of epileptic seizures after craniocerebral injury, and the number of side effects of the drugs in the prevention of epileptic seizures after craniocerebral injury, and there is no significant difference between them in terms of the length of stay in the hospital. [-4.972.91] .Conclusion\% LEV and PHT are equally effective in the prevention of epilepsy after brain injury. The mortality rate and length of stay were not superior to that of PHT. However, there were more patients in LEV group than those in LEV group who needed to stop or change the treatment schedule because of side effects of the drug. The difference is statistically significant. According to the analysis of current evidence, PHT is still the first choice of drugs in patients with craniocerebral injury. However, when the drug side effects and drug interactions are intolerable, Lev is a good alternative therapy. Because the high quality RCTs included in this meta-analysis are relatively few, it is necessary to carry out prospective and large samples for the two drugs. Multicenter, cross-racial, high-quality research.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1;R651.15

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