本文選題：癲癇 + 治療現(xiàn)狀��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的： 了解吉林省農(nóng)村地區(qū)驚厥型癲癇治療現(xiàn)狀以及苯巴比妥、丙戊酸鈉的療效、不良反應(yīng)，進(jìn)一步探討在農(nóng)村經(jīng)濟(jì)欠發(fā)達(dá)地區(qū)如何有效地控制癲癇發(fā)作，如何規(guī)范使用抗癲癇藥物，盡可能的降低治療費(fèi)用，減輕患者及家屬心理和經(jīng)濟(jì)負(fù)擔(dān)，降低癲癇患者的發(fā)作頻率及死亡率，提高其生活質(zhì)量。 方法： 選定吉林省7個(gè)縣/市（磐石、樺甸、通化、敦化、扶余、輝南、洮南）開展農(nóng)村癲癇項(xiàng)目，由經(jīng)過培訓(xùn)的鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)生對(duì)已確定或可疑驚厥型癲癇的患者進(jìn)行初步篩查，再由負(fù)責(zé)本項(xiàng)目的縣級(jí)神經(jīng)科醫(yī)師進(jìn)行復(fù)查，決定該患者是否進(jìn)入治療管理組，給予免費(fèi)的苯巴比妥治療，苯巴比妥治療效果不好的患者轉(zhuǎn)為丙戊酸鈉治療。由鄉(xiāng)鎮(zhèn)衛(wèi)生院醫(yī)生對(duì)入組的患者進(jìn)行定期隨訪，并填寫隨訪表，使用EpiData3.1、SPSS17.0軟件完成數(shù)據(jù)錄入及數(shù)據(jù)分析，以此了解吉林省癲癇治療現(xiàn)狀及苯巴比妥、丙戊酸鈉的療效、不良反應(yīng)。 結(jié)果： 共篩查2192名患者，男性1234人，占56.3%，女性958人，占43.7%。男女比為1.29：1；平均年齡41.13±15.187，0-20歲發(fā)病的癲癇患者1241人，約占56.6%；活動(dòng)性癲癇1080人，約占總?cè)藬?shù)的83.1%；治療缺口為40.72%。不正規(guī)治療包括：中藥、針灸、割治、埋線、民間土方；最常見的發(fā)作類型為全面強(qiáng)直-陣攣發(fā)作，共1543人，約占72.8%；納入苯巴比妥治療的癲癇患者1218例，納入丙戊酸鈉治療的癲癇患者165例，其中退組222人，最常見的原因是由于家人反對(duì)，不同意用藥或者是用藥后效果不好；癲癇患者死亡30人，最常見的死亡原因是腦血管病9例，占30%；苯巴比妥輕度不良反應(yīng)常見為困倦、嗜睡，頭暈、頭痛，無嚴(yán)重不良反應(yīng)；服藥滿一年的癲癇患者顯著率為71.3%，有效率為4.9%，總有效率為76.2%；苯巴比妥多因素分析顯示：正規(guī)治療對(duì)于最終療效是一個(gè)保護(hù)因素，關(guān)聯(lián)強(qiáng)度OR值為0.376（95%C.I.為0.216-0.655）；丙戊酸鈉常見的不良反應(yīng)是：頭痛、困倦疲乏、惡心嘔吐。1年的總有效率可達(dá)92.2%。由于樣本量較小，多因素分析未顯示有意義的因素。 結(jié)論： 吉林省農(nóng)村地區(qū)癲癇患者男女比例為1.29:1，其中兒童及青少年發(fā)病率高于成人，治療缺口為40.72%，，不正規(guī)治療包括：中藥、針灸、割治、埋線、民間土方。經(jīng)過系統(tǒng)正規(guī)的農(nóng)村癲癇項(xiàng)目管理，現(xiàn)吉林省癲癇治療現(xiàn)狀有所改觀。苯巴比妥、丙戊酸鈉的人群耐受性較好，出現(xiàn)不良反應(yīng)的患者較少，長(zhǎng)期服用較為安全。苯巴比妥、丙戊酸鈉治療驚厥型癲癇療效較好，小中劑量就可獲得較好的癲癇控制效果。影響療效最重要的因素是有無正規(guī)治療。
[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 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.1

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