吉林省农村地区癫痫治疗现状及药物规范化治疗探讨

发布时间：2018-04-24 09:52

本文选题：癫痫 + 治疗现状　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：了解吉林省农村地区惊厥型癫痫治疗现状以及苯巴比妥、丙戊酸钠的疗效、不良反应，进一步探讨在农村经济欠发达地区如何有效地控制癫痫发作，如何规范使用抗癫痫药物，尽可能的降低治疗费用，减轻患者及家属心理和经济负担，降低癫痫患者的发作频率及死亡率，提高其生活质量。方法：选定吉林省7个县/市（磐石、桦甸、通化、敦化、扶余、辉南、洮南）开展农村癫痫项目，由经过培训的乡镇卫生院医生对已确定或可疑惊厥型癫痫的患者进行初步筛查，再由负责本项目的县级神经科医师进行复查，决定该患者是否进入治疗管理组，给予免费的苯巴比妥治疗，苯巴比妥治疗效果不好的患者转为丙戊酸钠治疗。由乡镇卫生院医生对入组的患者进行定期随访，并填写随访表，使用EpiData3.1、SPSS17.0软件完成数据录入及数据分析，以此了解吉林省癫痫治疗现状及苯巴比妥、丙戊酸钠的疗效、不良反应。结果：共筛查2192名患者，男性1234人，占56.3%，女性958人，占43.7%。男女比为1.29：1；平均年龄41.13±15.187，0-20岁发病的癫痫患者1241人，约占56.6%；活动性癫痫1080人，约占总人数的83.1%；治疗缺口为40.72%。不正规治疗包括：中药、针灸、割治、埋线、民间土方；最常见的发作类型为全面强直-阵挛发作，共1543人，约占72.8%；纳入苯巴比妥治疗的癫痫患者1218例，纳入丙戊酸钠治疗的癫痫患者165例，其中退组222人，最常见的原因是由于家人反对，不同意用药或者是用药后效果不好；癫痫患者死亡30人，最常见的死亡原因是脑血管病9例，占30%；苯巴比妥轻度不良反应常见为困倦、嗜睡，头晕、头痛，无严重不良反应；服药满一年的癫痫患者显著率为71.3%，有效率为4.9%，总有效率为76.2%；苯巴比妥多因素分析显示：正规治疗对于最终疗效是一个保护因素，关联强度OR值为0.376（95%C.I.为0.216-0.655）；丙戊酸钠常见的不良反应是：头痛、困倦疲乏、恶心呕吐。1年的总有效率可达92.2%。由于样本量较小，多因素分析未显示有意义的因素。结论：吉林省农村地区癫痫患者男女比例为1.29:1，其中儿童及青少年发病率高于成人，治疗缺口为40.72%，，不正规治疗包括：中药、针灸、割治、埋线、民间土方。经过系统正规的农村癫痫项目管理，现吉林省癫痫治疗现状有所改观。苯巴比妥、丙戊酸钠的人群耐受性较好，出现不良反应的患者较少，长期服用较为安全。苯巴比妥、丙戊酸钠治疗惊厥型癫痫疗效较好，小中剂量就可获得较好的癫痫控制效果。影响疗效最重要的因素是有无正规治疗。
[Abstract]:Objective: To understand the current situation of epilepsy treatment in rural areas of Jilin Province, the curative effect and adverse reactions of phenobarbital and sodium valproate, and to further explore how to control seizures effectively and how to regulate the use of antiepileptic drugs in underdeveloped rural areas. As far as possible to reduce the cost of treatment, reduce the psychological and economic burden of patients and their families, reduce the frequency of seizures and mortality, improve their quality of life. Methods: Seven counties / cities in Jilin Province (Panshi, Huadian, Tonghua, Dunhua, Fuyu, Huinan, Taonan) were selected to carry out rural epilepsy projects, and the trained doctors of township health centers were selected to carry out preliminary screening of patients with confirmed or suspected convulsive epilepsy. Then the county-level neurologists responsible for this project recheck and decide whether the patient should enter the treatment management group and give free phenobarbital treatment. The patients with poor phenobarbital treatment effect will be converted into sodium valproate treatment. The patients were followed up regularly by the doctors of township health centers, and the data input and data analysis were completed by using EpiData3.1 and SPSS 17.0 software, so as to understand the current status of epilepsy treatment in Jilin Province and the curative effect and adverse reactions of phenobarbital and sodium valproate. Results: A total of 2192 patients were screened, 1234 males (56.3%) and 958 females (43.7%). The ratio of male to female was 1.29: 1; the average age was 41.13 卤15.187 ~ 20 years old with 1241 epileptic patients (56.6%), 1080 active epilepsy (83.1%), and 40.72% gap in treatment. Irregular treatment includes: traditional Chinese medicine, acupuncture, cutting, thread embedding, folk earthwork; the most common type of seizure is comprehensive tonic-clonic seizure, with a total of 1543 people, accounting for about 72.8; and 1218 epileptic patients who were treated with phenobarbital. Among 165 epileptic patients who were treated with sodium valproate, 222 were in the retreating group, the most common reason being that they did not agree with the medication or the effect was not good because of family opposition; 30 people died of epilepsy. The most common cause of death was cerebrovascular disease in 9 cases (30 cases), mild adverse reactions of phenobarbital were sleepiness, lethargy, dizziness, headache and no serious adverse reactions. The significant rate of epileptic patients was 71.3%, the effective rate was 4.9 and the total effective rate was 76.20.The multivariate analysis of phenobarbital showed that regular treatment was a protective factor for the final curative effect, and the OR value of association strength was 0.376n95C.I. The common adverse reactions of valproate sodium valproate were headache, fatigue, nausea and vomiting. The total effective rate of 1 year was 92. 2%. Because of the small sample size, multivariate analysis showed no significant factors. Conclusion: The ratio of male and female epileptic patients in rural areas of Jilin Province was 1.29: 1, in which the morbidity of children and adolescents was higher than that of adults, and the treatment gap was 40.722.The irregular treatment included: traditional Chinese medicine, acupuncture, cutting, thread embedding, folk earthwork. Through systematic formal rural epilepsy project management, the current situation of epilepsy treatment in Jilin Province has improved. Phenobarbital, valproate sodium people have better tolerance, adverse reactions of patients are less, long-term use is safer. Phenobarbital and valproate are effective in the treatment of convulsive epilepsy. The most important factor affecting the efficacy is the availability of regular treatment.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

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