本文選題：癲癇 + 心率��； 參考：《揚(yáng)州大學(xué)》2014年碩士論文

【摘要】：本文主要研究新型抗癲癇藥物左乙拉西坦聯(lián)合丙戊酸鈉治療全面性癲癇持續(xù)狀態(tài)療效分析,進(jìn)而指導(dǎo)臨床治療癲癇持續(xù)狀態(tài)。在綜述中對(duì)癲癇持續(xù)狀態(tài)發(fā)病機(jī)制、病因、對(duì)機(jī)體影響及癲癇持續(xù)狀態(tài)治療,癲癇對(duì)女性生殖內(nèi)分泌系統(tǒng)的影響綜述文獻(xiàn)的基礎(chǔ)上,首先,從癲癇患者癲癇發(fā)作對(duì)心臟影響相關(guān)參數(shù)觀察,進(jìn)一步分析癲癇發(fā)作對(duì)心率、心律、心肌改變推測(cè)。其次,從臨床上研究左乙拉西坦聯(lián)合丙戊酸鈉注射液治療癲癇持續(xù)狀態(tài),對(duì)比單藥丙戊酸鈉注射液治療癲癇持續(xù)狀態(tài)療效、副作用,闡述其相關(guān)機(jī)制,進(jìn)而探討左乙拉西坦聯(lián)合丙戊酸鈉治療全面性癲癇持續(xù)狀態(tài)臨床觀察。 第一部分 癲癇患者發(fā)作前后心肌損傷自身對(duì)照研究 目的 研究癲癇患者癲癇發(fā)作對(duì)心肌、心電圖、心率影響變化。 方法 癲癇發(fā)作間歇期門診隨訪時(shí)門診隨訪時(shí)常規(guī)檢查十二導(dǎo)心電圖、心肌酶、肌鈣蛋白等指標(biāo)作為發(fā)作前�；颊咴俅伟l(fā)作全面性癲癇入院患者2h內(nèi)檢查心電圖、心肌酶、肌鈣蛋白等指標(biāo)為發(fā)作后。并對(duì)癲癇發(fā)作前后心肌酶、肌鈣蛋白數(shù)據(jù)采用SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05表示為差異有顯著性。 結(jié)果 癲癇患者發(fā)作后2h內(nèi)CK對(duì)比發(fā)作前CK明顯升高(P0.01),癲癇患者發(fā)作后2h內(nèi)CKMB對(duì)比發(fā)作前CKMB明顯升高(P0.01),癲癇患者發(fā)作后2h內(nèi)LDH對(duì)比發(fā)作前LDH明顯升高(P0.01),癲癇患者發(fā)作后1h cTn I對(duì)比發(fā)作前cTnI明顯升高(P0.01)。20例患者發(fā)作時(shí)18例心率明顯增快,1例癲癇患者發(fā)作時(shí)心率無明顯變化,1例患者發(fā)作時(shí)心率變慢。有12例癲癇患者在癲癇發(fā)作時(shí)心電圖出現(xiàn)(除外竇性心動(dòng)過速)異常,而8例患者心電圖正常。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間期延長(zhǎng)1例,Ⅰ度房室傳導(dǎo)阻滯1例。 結(jié)論 癲癇患者癲癇發(fā)作時(shí)有明顯心率波動(dòng)、心電圖異常及心肌缺血改變,其機(jī)理可能與癲癇頻繁發(fā)作導(dǎo)致心臟自主神經(jīng)紊亂所致。 第二部分 左乙拉西坦聯(lián)合丙戊酸鈉對(duì)比單藥丙戊酸鈉治療全面性癲癇持續(xù)狀態(tài)的臨床研究 目的 探討左乙拉西坦口服藥物治療聯(lián)合丙戊酸鈉治療癲癇持續(xù)狀態(tài)對(duì)比單藥丙戊酸鈉治療癲癇持續(xù)狀態(tài)的有效性及安全性,及對(duì)心臟變化。 方法 丙戊酸鈉組起始予以德巴金注射液1mg/kg.h速度微量泵持續(xù)泵入48h,病情穩(wěn)定后改為德巴金口服或鼻飼。左乙拉西坦-丙戊酸鈉組起始予以丙戊酸鈉注射液1mg/kg.h速度微量泵持續(xù)泵入,同時(shí)插入鼻飼管每天注入左乙拉西坦,第一天的初始計(jì)量1g/d,分2次服用,逐漸加量,直至有效控制癲癇發(fā)作,最大計(jì)量3g/d,病情穩(wěn)定后,改為口服藥物。比較兩組治療后的有效率、起效時(shí)間、控制時(shí)間、蘇醒時(shí)間、兩組心肌酶譜、肌鈣蛋白變化、用藥劑量指標(biāo)。 結(jié)果 左乙拉西坦聯(lián)合丙戊酸鈉組治療癲癇持續(xù)狀態(tài)患者蘇醒時(shí)間、控制時(shí)間、起效時(shí)間短于單藥丙戊酸鈉組,且有統(tǒng)計(jì)學(xué)意義(P0.01)；左乙拉西坦聯(lián)合丙戊酸鈉治療癲癇持續(xù)狀態(tài)總有效率大于單藥治療癲癇持續(xù)狀態(tài),但無統(tǒng)計(jì)學(xué)意義(P0.05)；左乙拉西坦聯(lián)合丙戊酸鈉治療癲癇持續(xù)狀態(tài)較單藥丙戊酸鈉治療癲癇持續(xù)狀態(tài)復(fù)發(fā)率低,但無統(tǒng)計(jì)學(xué)差異(P0.05),左乙療效西坦聯(lián)合丙戊酸鈉組治療癲癇后6h CK、CKMB、LDH、cTn I明顯低于單藥丙戊酸鈉組(P0.01),且有統(tǒng)計(jì)學(xué)意義。 結(jié)論 本研究中口服左乙拉西坦聯(lián)合丙戊酸鈉治療癲癇持續(xù)狀態(tài)起效快,患者蘇醒時(shí)間短,復(fù)發(fā)率低,對(duì)心臟損害減少,值得進(jìn)一步觀察和研究。
[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 .

【學(xué)位授予單位】：揚(yáng)州大學(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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本文編號(hào)：1836344