生酮饮食添加治疗儿童痉挛性癫痫临床观察

发布时间：2018-03-14 14:28

本文选题：生酮饮食　切入点：痉挛性癫痫　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]观察生酮饮食(ketogenicdiet,KD)添加治疗儿童痉挛性癫痫的临床疗效及不良反应和依从性。[方法]对2015年5月至2017年1月在昆明医科大学第一附属医院儿科及合作医院接受KD添加治疗的19例痉挛性癫痫患儿,通过临床随访,根据Engel分级评价KD添加治疗1、3、6个月的疗效,记录不良反应、退出治疗原因。同时分析并记录以上各时间点脑电图变化情况,指导并要求家长对患儿语言、运动及行为的进步或倒退进行详细观察及记录。[结果]19例以痉挛性发作为主要表现的癫痫患儿,男7例,女12例,年龄3个月至5岁5个月,KD添加治疗1、3、6个月的总有效率分别为78.9%、77.8%、86.7%,其中完全控制发作分别有3例、4例、4例,完全控制发作率(I级)分别为15.8%、22.2%、26.7%,KD添加治疗疗效与治疗时间、年龄、性别差异无统计学意义(P0.05)。KD添加治疗1、3、6个月后脑电图好转率分别为31.6%、72.2%、86.7%,不同时间脑电图变化差异无统计学意义(P0.05),KD添加治疗3个月患儿不同EEG变化,其临床疗效差异有统计学意义(P0.05)。KD添加治疗6个月后共有15例发育进步,其中11例伴有大运动能力进步,5例认知功能改善,4例出现语言能力进步。主要不良反应为消化道症状,均较轻微,无严重不良反应。治疗疗程大于6个月者15例,目前13例仍继续治疗,其余6例因短期治疗无效、饮食不耐受、消化道症状等原因终止治疗。[结论]KD添加治疗对痉挛性癫痫治疗安全有效,起效快。超过85%的发作减少,发育进步15例。目前尚未观察到严重不良反应。还需要加强生酮饮食管理,改善饮食配方,加强健康宣教,提高患儿及家属的依从性,从而对更大样本进行更长时间临床观察,为痉挛性癫痫患儿提供更合适更有效的治疗方案。
[Abstract]:[objective] to observe the clinical efficacy, adverse reactions and compliance of ketogenic dietate (KD) supplementation in the treatment of children with spastic epilepsy. [methods] from May 2015 to January 2017, pediatrics and cooperative hospital of the first affiliated Hospital of Kunming Medical University were selected. 19 children with spastic epilepsy received KD adjunctive therapy, According to the clinical follow-up, according to the Engel grade to evaluate the curative effect of KD plus therapy for 3 months and 6 months, to record the adverse reactions and the reasons for withdrawing from the treatment. At the same time, to analyze and record the changes of EEG at the above time points, and to instruct and request parents to speak the children's children. Movement and behavior progress or regression were observed and recorded in detail. [results] 19 epileptic children with spasmodic hair as the main manifestation, 7 males and 12 females, The total effective rates were 78.9% 77.8% and 86.7% respectively for 3 months to 5 months old and 5 months old and 5 months old, respectively. Among them, 3 cases (4 cases) with complete control attack, 4 cases with complete control attack rate (grade I) were 15. 8% 22. 2% and 26. 7% of the total effective rate, respectively, and the curative effect and treatment time, age, and age of addition therapy were 15. 8% and 22. 2% respectively. There was no significant difference in sex between the two groups. The improvement rate of EEG after 6 months was 31.6% and 72.2%, respectively. There was no significant difference in EEG changes at different time points. There were significant differences in clinical efficacy between 15 patients with developmental progress after 6 months of P0.05N. KD adjunctive therapy. Among them, 11 cases were accompanied with great motor ability improvement and 5 cases with cognitive improvement and 4 cases with language improvement. The main adverse reactions were digestive tract symptoms. The course of treatment was longer than 6 months in 15 cases, 13 cases were still treated, the remaining 6 cases were not effective because of short-term treatment, and the other 6 cases were not tolerant to diet. [conclusion] KD adjunctive therapy is safe, effective and effective in the treatment of spastic epilepsy. There are 15 cases of developmental progress. At present, no serious adverse reactions have been observed. It is also necessary to strengthen the management of ketone diet, improve diet formula, strengthen health education, and improve the compliance of children and their families, so as to conduct long-term clinical observation on a larger sample. To provide more appropriate and effective treatment for children with spastic epilepsy.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R742.1

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