發(fā)布時(shí)間：2018-03-16 09:41

  本文選題：LEV　切入點(diǎn)：PHT　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:系統(tǒng)評(píng)價(jià)左乙拉西坦(LEV)與苯妥英鈉(PHT)預(yù)防顱腦損傷后癇性發(fā)作的療效、藥物副作用及死亡率等。方法:通過關(guān)鍵詞PHT、LEV、顱腦損傷在Pubmed、Medline、Ovid、Springer、中國知網(wǎng)、萬方等數(shù)據(jù)庫,收集2000至2016年來國內(nèi)外針對(duì)LEV和PHT預(yù)防顱腦損傷后癇性發(fā)作的療效對(duì)比的高質(zhì)量研究,通過嚴(yán)格的納入和排除標(biāo)準(zhǔn),提取有效數(shù)據(jù)并利用Rev Man5.3軟件進(jìn)行薈萃分析。結(jié)果:經(jīng)文獻(xiàn)檢索、篩選后共納入13篇英文研究,共包含2529例患者。薈萃分析結(jié)果顯示:LEV組對(duì)比PHT組對(duì)癇性發(fā)作預(yù)防用藥效果評(píng)價(jià)上,差異沒有統(tǒng)計(jì)學(xué)意義(RR=0.88,95%CI[0.61,1.27]);對(duì)早期癇性發(fā)作預(yù)防用藥效果評(píng)價(jià)上,差異沒有統(tǒng)計(jì)學(xué)意義(RR=0.74,95%CI[0.42,1.27]);對(duì)晚期癲癇預(yù)防用藥效果評(píng)價(jià)上,差異沒有統(tǒng)計(jì)學(xué)意義(RR=0.71,95%CI[0.43,1.20]);兩藥對(duì)比在藥物副作用的人數(shù)上,差異沒有統(tǒng)計(jì)學(xué)意義(RR=0.73,95%CI[0.48,1.11]),但在因藥物副作用需要停藥或改變治療方案的患者,PHT組多于LEV組,差異有統(tǒng)計(jì)學(xué)意義(RR=0.11,95%CI[0.06,0.23]);在預(yù)防用藥對(duì)死亡率的比較分析中,差異沒有統(tǒng)計(jì)學(xué)意義(RR=1.57,95%CI[0.92,2.67]);在住院時(shí)間長短上兩者差異無統(tǒng)計(jì)學(xué)意義(WMD=-1.03,95%CI[-4.97,2.91])。結(jié)論:LEV和PHT在顱腦損傷后癇性發(fā)作的預(yù)防上有同等效力;在藥物副作用的人數(shù)、死亡率及住院時(shí)間方面,LEV與PHT相比沒有優(yōu)勢。但在因藥物副作用而需要停藥或改變治療方案的患者,PHT組多于LEV組,差異有統(tǒng)計(jì)學(xué)意義。根據(jù)目前的證據(jù)分析得出PHT仍是顱腦損傷患者藥物的首選,但當(dāng)其出現(xiàn)不可耐受的藥物副作用及藥物相互作用時(shí),LEV是一個(gè)很好的替代治療。由于本薈萃分析納入的高質(zhì)量的隨機(jī)對(duì)照試驗(yàn)(RCT)較少,有必要針對(duì)兩藥開展前瞻性、大樣本、多中心、跨種族人群的高質(zhì)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 鹵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.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1;R651.15

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