本文選題：兒童睡眠中癲癇性電持續(xù)狀態(tài) + 皮質(zhì)類固醇激素��； 參考：《南昌大學(xué)》2012年碩士論文

【摘要】：目的：兒童睡眠期癲癇性電持續(xù)狀態(tài)（electrical status epilepticus during sleep，ESES）是小兒時(shí)期一種特有的電現(xiàn)象，是指患者慢波睡眠期出現(xiàn)持續(xù)或幾乎持續(xù)的局限性或廣泛性棘慢波發(fā)放，通常以棘慢波指數(shù)（SWI）≥50%為標(biāo)準(zhǔn)。雖然僅占癲癇患兒的0.5%，但常常伴有神經(jīng)心理學(xué)方面的損傷，甚至較癲癇發(fā)作更突出，其治療的重點(diǎn)在于消除電持續(xù)狀態(tài)。近來(lái)的研究報(bào)道表明，皮質(zhì)類固醇激素治療對(duì)消除電持續(xù)狀態(tài)，改善神經(jīng)心理學(xué)損傷有效果。由于ESES可在諸如CSWS、LKS、LGS、BECTS等多種癲癇綜合征中合并發(fā)生，大多數(shù)類型常有嚴(yán)重的精神運(yùn)動(dòng)發(fā)育遲滯。其中BECTS合并ESES的患兒是其中預(yù)后最好的一種，便于進(jìn)行認(rèn)知方面的測(cè)定。本文選擇了60例BECTS合并ESES的患兒，分別予以傳統(tǒng)抗癲癇藥物和甲潑尼龍沖擊聯(lián)用傳統(tǒng)抗癲癇藥物治療，以評(píng)價(jià)甲潑尼龍沖擊治療ESES的臨床療效及對(duì)認(rèn)知的影響。 方法：60例BECTS合并ESES的患兒，隨機(jī)分為治療組和對(duì)照組。治療組給予甲潑尼龍序貫潑尼松治療，具體為甲潑尼龍15~20mg/kg·d，連用3天，每周1個(gè)療程，共3個(gè)療程，之后予潑尼松1.5~2.0mg/kg·d，4~12周后減量，視病情維持療程至4~6個(gè)月，期間維持患兒原有抗癲癇藥物不變。對(duì)照組按照患兒個(gè)人發(fā)作類型不同給予丙戊酸鈉、奧卡西平、托吡酯、左乙拉西坦、拉莫三嗪等藥物治療。并在治療后6月時(shí)隨訪。治療前后分別記錄腦電圖、行韋氏兒童智力測(cè)試，觀察發(fā)作控制情況及藥物不良反應(yīng)，對(duì)比分析甲潑尼龍沖擊療法的療效結(jié)果。結(jié)果以x±s表示，SPSS18.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析，組間比較采用t檢驗(yàn)。P＜0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果： ①臨床療效治療組30例中，發(fā)作控制7例，有效20例，，無(wú)效3例，總有效率90.0%；對(duì)照組30例中，發(fā)作控制6例，有效17例，無(wú)效7例，總有效率76.7%；兩組臨床療效比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。 ②腦電圖變化治療組30例中，有效25例，無(wú)效5例，有效率83.3%；對(duì)照組30例中，有效17例，無(wú)效13例，有效率56.7%；兩組間腦電圖治療有效率經(jīng)比較，差異有統(tǒng)計(jì)學(xué)意義（P0.05)。 ③認(rèn)知功能變化分為4-6歲兒童組和6-15歲兒童組，兩項(xiàng)分組中，治療組與對(duì)照組用藥前各項(xiàng)結(jié)果差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；治療組用藥6月后與治療前相比較，言語(yǔ)智商（VIQ）、操作智商（PIQ）總智商（FIQ）均有增加（P0.05)；對(duì)照組治療6月后與治療前比較VIQ、FIQ、PIQ無(wú)明顯差異(P0.05);用藥6月后治療組與對(duì)照組相比較，治療組VIQ、PIQ、FIQ得分均高于對(duì)照組，有統(tǒng)計(jì)學(xué)意義(P0.05)。 ④不良反應(yīng)激素治療組可有因皮質(zhì)激素引起的不良反應(yīng)，且主要在激素治療期間出現(xiàn)，包括感染8例（26.7%），體重增加、庫(kù)欣面容30例（100%）、低鉀血癥1例（3.3%）。在激素減停后，上述不良反應(yīng)均消失。隨訪6月間，治療組觀察到的不良反應(yīng)率23.3%；對(duì)照組觀察到的不良反應(yīng)率為：26.7%；治療組與對(duì)照組不良反應(yīng)發(fā)生率比較，無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論： 1、甲潑尼龍沖擊治療ESES，在臨床發(fā)作控制方面效果與單用傳統(tǒng)抗癲癇藥物相似。 2、甲潑尼龍沖擊治療ESES與單用傳統(tǒng)抗癲癇藥物對(duì)于患兒腦電圖的緩解均有效果，甲潑尼龍沖擊治療效果更顯著。 3、甲潑尼龍沖擊治療對(duì)ESES患兒的認(rèn)知能力有部分改善，而單用傳統(tǒng)抗癲癇藥物不能緩解患兒認(rèn)知能力。 4、甲潑尼龍沖擊治療的特殊不良反應(yīng)有感染、體重增加等，但停藥后可消失，其他不良反應(yīng)率相較單用傳統(tǒng)抗癲癇藥物的相當(dāng)，無(wú)顯著差異。
[Abstract]:Objective: electrical status epilepticus during sleep (ESES) in children's sleep period is a special electrical phenomenon in childhood. It refers to the persistent or almost continuous limited or widespread spinous wave distribution in the slow wave sleep period, usually with the einous wave index (SWI) more than 50% as the standard. Although only the epileptic patients are suffering from epilepsy. 0.5%, but often accompanied by neuropsychological damage, even more prominent than epileptic seizures, the focus of their treatment is to eliminate electrical persistence. Recent studies have shown that corticosteroid therapy has an effect on eliminating electrical persistence and improving neuropsychological damage. Because ESES can be used in such cases as CSWS, LKS, LGS, BECTS and so on. Most types often have severe psychomotor retardation in most types of epilepsy syndrome. Among them, children with BECTS combined with ESES are the best one with the best prognosis. In this paper, 60 children with BECTS combined with ESES were selected for traditional antiepileptic drugs and methylprednisolone impact combined with traditional resistance. Epileptic drug therapy was used to evaluate the clinical efficacy and cognitive effects of methylprednisolone pulse therapy on ESES.
Methods: 60 children with BECTS combined with ESES were randomly divided into the treatment group and the control group. The treatment group was treated with prednisolone with prednisolone, specific for methylprednisolone 15~20mg/kg. D, for 3 days, 1 courses per week, 3 courses of treatment, then prednisone 1.5~2.0mg/kg D, 4~12 weeks after 4~12, and maintained a course of treatment to 4~6 months, during the period of 4~6 months, during the period of maintenance. The control group was treated with sodium valproate, oxcarbazepine, topiramate, levetiracetam, lamotrigine and other drugs in accordance with the types of individual seizures in the children. The electroencephalogram was recorded before and after the treatment, and the Wechsler intelligence test was performed before and after the treatment to observe the seizure control and adverse drug reactions. The results of methylprednisolone impact therapy were compared and analyzed. The results were x + s, SPSS18.0 statistical software was statistically analyzed, and.P < 0.05 was statistically significant between groups using t test.
Result錛

本文編號(hào)：1954696