左乙拉西坦联合丙戊酸注射液治疗癫痫持续临床观察

发布时间：2018-05-03 01:20

本文选题：癫痫 + 心率　；参考：《扬州大学》2014年硕士论文

【摘要】：本文主要研究新型抗癫痫药物左乙拉西坦联合丙戊酸钠治疗全面性癫痫持续状态疗效分析,进而指导临床治疗癫痫持续状态。在综述中对癫痫持续状态发病机制、病因、对机体影响及癫痫持续状态治疗,癫痫对女性生殖内分泌系统的影响综述文献的基础上,首先,从癫痫患者癫痫发作对心脏影响相关参数观察,进一步分析癫痫发作对心率、心律、心肌改变推测。其次,从临床上研究左乙拉西坦联合丙戊酸钠注射液治疗癫痫持续状态,对比单药丙戊酸钠注射液治疗癫痫持续状态疗效、副作用,阐述其相关机制,进而探讨左乙拉西坦联合丙戊酸钠治疗全面性癫痫持续状态临床观察。第一部分癫痫患者发作前后心肌损伤自身对照研究目的研究癫痫患者癫痫发作对心肌、心电图、心率影响变化。方法癫痫发作间歇期门诊随访时门诊随访时常规检查十二导心电图、心肌酶、肌钙蛋白等指标作为发作前。患者再次发作全面性癫痫入院患者2h内检查心电图、心肌酶、肌钙蛋白等指标为发作后。并对癫痫发作前后心肌酶、肌钙蛋白数据采用SPSS17.0进行统计学分析,P0.05表示为差异有显著性。结果癫痫患者发作后2h内CK对比发作前CK明显升高(P0.01),癫痫患者发作后2h内CKMB对比发作前CKMB明显升高(P0.01),癫痫患者发作后2h内LDH对比发作前LDH明显升高(P0.01),癫痫患者发作后1h cTn I对比发作前cTnI明显升高(P0.01)。20例患者发作时18例心率明显增快,1例癫痫患者发作时心率无明显变化,1例患者发作时心率变慢。有12例癫痫患者在癫痫发作时心电图出现(除外窦性心动过速)异常,而8例患者心电图正常。其中ST段降低2例,ST段抬高1例,T波倒置2例,室性早搏2例,房性早搏3例,QT间期延长1例,Ⅰ度房室传导阻滞1例。结论癫痫患者癫痫发作时有明显心率波动、心电图异常及心肌缺血改变,其机理可能与癫痫频繁发作导致心脏自主神经紊乱所致。第二部分左乙拉西坦联合丙戊酸钠对比单药丙戊酸钠治疗全面性癫痫持续状态的临床研究目的探讨左乙拉西坦口服药物治疗联合丙戊酸钠治疗癫痫持续状态对比单药丙戊酸钠治疗癫痫持续状态的有效性及安全性,及对心脏变化。方法丙戊酸钠组起始予以德巴金注射液1mg/kg.h速度微量泵持续泵入48h,病情稳定后改为德巴金口服或鼻饲。左乙拉西坦-丙戊酸钠组起始予以丙戊酸钠注射液1mg/kg.h速度微量泵持续泵入,同时插入鼻饲管每天注入左乙拉西坦,第一天的初始计量1g/d,分2次服用,逐渐加量,直至有效控制癫痫发作,最大计量3g/d,病情稳定后,改为口服药物。比较两组治疗后的有效率、起效时间、控制时间、苏醒时间、两组心肌酶谱、肌钙蛋白变化、用药剂量指标。结果左乙拉西坦联合丙戊酸钠组治疗癫痫持续状态患者苏醒时间、控制时间、起效时间短于单药丙戊酸钠组,且有统计学意义(P0.01)；左乙拉西坦联合丙戊酸钠治疗癫痫持续状态总有效率大于单药治疗癫痫持续状态,但无统计学意义(P0.05)；左乙拉西坦联合丙戊酸钠治疗癫痫持续状态较单药丙戊酸钠治疗癫痫持续状态复发率低,但无统计学差异(P0.05),左乙疗效西坦联合丙戊酸钠组治疗癫痫后6h CK、CKMB、LDH、cTn I明显低于单药丙戊酸钠组(P0.01),且有统计学意义。结论本研究中口服左乙拉西坦联合丙戊酸钠治疗癫痫持续状态起效快,患者苏醒时间短,复发率低,对心脏损害减少,值得进一步观察和研究。
[Abstract]:In this paper , the author mainly studies the curative effect of the new anti - epileptic drugs on the persistent state of epilepsy , which is based on the analysis of the effect of epilepsy on the persistent state of epilepsy and the effect of epilepsy on the heart rate , rhythm and myocardial changes .

the first portion

A comparative study of myocardial injury before and after seizures in patients with epilepsy

Purpose

To study the effect of seizures on myocardium , electrocardiogram and heart rate in patients with epilepsy .

method

The ECG , myocardial enzyme and troponin I were examined by routine examination at the follow - up time of the follow - up of the outpatient follow - up in the patients with epilepsy . The indexes of electrocardiogram , myocardial enzyme and troponin were examined in 2 hours after the onset of epileptic seizure , and the myocardial enzymes and troponin data before and after the seizure were analyzed by SPSS 17.0 , and the difference was significant .

Results

There was a significant increase in CK ( P0.01 ) before the onset of seizure , and the CK MB increased significantly in 2 hours after seizure ( P0.01 ) . In the patients with epilepsy , the heart rate increased significantly ( P0.01 ) .

Conclusion

Patients with epilepsy have obvious heart rate fluctuation , abnormal electrocardiogram and myocardial ischemia , and their mechanism may be caused by frequent seizures of epilepsy .

the second part

A Clinical Study on the Treatment of Comprehensive Epilepsy with Sodium Valproate Combined with Sodium Valproate in the Treatment of Comprehensive Epilepsy

Purpose

Objective To investigate the efficacy and safety of the treatment of epilepsy with sodium valproate combined with sodium valproate in combination with sodium valproate in the treatment of epilepsy , and to change the heart rate .

method

The initial dose of sodium valproate ( 1 mg / kg 路 h ) was continuously pumped at 1 mg / kg 路 h at the initial dose of 1 g / d . The effective rate , effective time , control time , time of wake - up time , myocardial enzyme spectrum , troponin change and dosage index were compared between the two groups .

Results

The time and duration of control were shorter than that of sodium valproate alone ( P0.01 ) .
The total effective rate in the treatment of the status epilepticus was higher than that in the monotherapy group ( P0.05 ) .
Compared with the single - drug sodium valproate group ( P0.01 ) , there was no statistical difference ( P 0 . 05 ) , and the level of CK , CKMB , LDH and cTn I in the patients with epilepsy were significantly lower than that of sodium valproate alone ( P0.01 ) .

Conclusion

In this study , the effect of oral administration of levamlodipine combined with sodium valproate in the treatment of epilepsy was rapid , the duration of the patient ' s wake - up time was short , the recurrence rate was low , the damage to the heart was reduced , and the study was worth further observation and study .

【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.1

【参考文献】