本文選題：癲癇 + 兒童　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的研究服用單種抗癲癇藥物進(jìn)行治療的癲癇兒童存在的情緒行為問(wèn)題,并分析常見(jiàn)的抗癲癇藥物對(duì)情緒行為造成的不同影響,從而更好地指導(dǎo)抗癲癇藥物的選用。方法收集2014年9月-2016年6月于我院兒科門診和病房就診的服用托吡酯(TPM)、丙戊酸鈉(VPA)、左乙拉西坦(LEV)進(jìn)行單藥治療的原發(fā)性癲癇患兒作為病例組,同時(shí)收集期間新診斷為癲癇但尚未開(kāi)始治療的患兒和健康兒童作為對(duì)照組,對(duì)其使用Achenbach兒童行為量表(CBCL,家長(zhǎng)用)進(jìn)行情緒行為問(wèn)題的評(píng)定。通過(guò)單因素方差分析和Kruskal-Wallis檢驗(yàn)比較各組癲癇兒童的一般情況、異常行為發(fā)生率、各因子得分和CBCL總得分。結(jié)果(1)癲癇兒童行為異常的總檢出率為7.7%,各組的檢出率比較:LEV組(11.5%)TPM組(9.1%)新發(fā)未服藥組(7.1%)VPA組(3.4%)健康兒童(0),但各組間的差異無(wú)統(tǒng)計(jì)學(xué)意義(χ~2=1.344,P0.05)。男性患兒行為異常檢出率(9.1%)高于女性患兒(2.3%),但差異無(wú)統(tǒng)計(jì)學(xué)意義(χ~2=1.873,P0.05)。(2)CBCL量表按四個(gè)不同性別年齡段(6-11歲男性及女性,12-16歲男性及女性)對(duì)各組的情緒行為因子的得分進(jìn)行比較,結(jié)果顯示:(1)6-11歲男性癲癇患兒,在分裂樣、強(qiáng)迫性方面:LEV組VPA組TPM組新發(fā)組健康組;在體訴、違紀(jì)方面:TPM組VPA組LEV組新發(fā)組健康組;在抑郁、交往不良、社交退縮、多動(dòng)、攻擊性、CBCL總分方面:TPM組LEV組VPA組新發(fā)組健康組。具有顯著統(tǒng)計(jì)學(xué)差異(P0.05)的為多動(dòng):TPM組明顯高于VPA組、新發(fā)未服藥組、健康組;抑郁方面,TPM明顯高于新發(fā)未服藥組、健康組;攻擊性方面,TPM、VPA明顯高于新發(fā)未服藥組、健康組;CBCL總分上,TPM組明顯高于新發(fā)未服藥組。(2)6-11歲女性癲癇患兒,在抑郁、體訴方面的得分比較:LEV組TPM組VPA組新發(fā)組健康組;社交退縮、多動(dòng)、攻擊性、總分方面:TPM組LEV組VPA組新發(fā)組健康組;分裂強(qiáng)迫:TPM組LEV組新發(fā)組VPA組健康組;具有顯著統(tǒng)計(jì)學(xué)差異(P0.05)的兩兩比較結(jié)果如下:抑郁方面,TPM組、LEV組明顯高于VPA組、新發(fā)組、健康組;多動(dòng)方面,TPM組明顯高于VPA組、新發(fā)未服藥組、健康組,LEV組明顯高于新發(fā)未服藥組;攻擊性方面,TPM組、LEV組明顯高于新發(fā)未服藥組、健康組;CBCL總分上,TPM組明顯高于VPA組、新發(fā)組、健康組,LEV組明顯高于新發(fā)未服藥組、健康組。(3)12-16歲的男性癲癇患兒,在體訴方面的得分比較:VPA組新發(fā)組TPM組LEV組健康組;分裂樣、交往不良、強(qiáng)迫性、違紀(jì)、攻擊性、CBCL總分方面:TPM組VPA組LEV組新發(fā)組健康組,其中TPM組交往不良的總分顯著高于健康組(P0.05)。不成熟方面:VPA組LEV組TPM組健康組新發(fā)組;敵意性:LEV組TPM組VPA組新發(fā)組健康組;多動(dòng):VPA組LEV組TPM組新發(fā)組健康組,其中TPM組交往不良的總分顯著高于健康組。(4)12-16歲女性癲癇患兒,焦慮強(qiáng)迫、抑郁退縮、CBCL總分方面的得分比較:LEV組VPA組新發(fā)組健康組;體訴、分裂樣、不成熟方面:VPA組LEV組新發(fā)組≥健康組;違紀(jì):LEV組新發(fā)組VPA組、健康組,各因子及CBCL總分之間的差別均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論(1)服用托吡酯單藥治療的6-11歲癲癇兒童較服用左乙拉西坦、丙戊酸更易出現(xiàn)多動(dòng)、社交退縮、違紀(jì)、攻擊等情緒行為問(wèn)題;而12-16歲癲癇男性患兒的情緒行為問(wèn)題發(fā)生率相對(duì)降低,主要表現(xiàn)為分裂樣、交往不良、強(qiáng)迫性、違紀(jì)、攻擊性等。(2)服用左乙拉西坦單藥治療的6-11歲癲癇兒童情緒行為問(wèn)題的發(fā)生率低于托吡酯組,但男性患兒的分裂樣、強(qiáng)迫性及女性患兒的抑郁、體訴發(fā)生率高于托吡酯、丙戊酸鈉組。12-16歲的癲癇兒童發(fā)生率相對(duì)降低,主要表現(xiàn)為敵意性、焦慮強(qiáng)迫、抑郁退縮、攻擊性等。(3)服用丙戊酸鈉單藥治療的6-11歲癲癇兒童的出現(xiàn)情緒行為問(wèn)題的可能性較小,相對(duì)多見(jiàn)的有分裂樣、強(qiáng)迫性、體訴、違紀(jì)等;但12-16歲年齡組的發(fā)生率相對(duì)增加,主要表現(xiàn)為不成熟、體訴、多動(dòng)、分裂樣等。(4)不同性別的癲癇兒童其情緒行為問(wèn)題的發(fā)生率無(wú)明顯差異。
[Abstract]:Objective to study the emotional and behavioral problems of epileptic children treated with single antiepileptic drugs, and to analyze the different effects of common antiepileptic drugs on emotional behavior, so as to better guide the selection of antiepileptic drugs. Methods to collect topiramate in the outpatient department of Pediatrics and ward of our hospital in September 2014, -2016 years, in June. (TPM) a single drug treatment of primary epilepsy in children with sodium valproate (VPA) and levetiracetam (LEV) as a case group. At the same time, children and healthy children who were newly diagnosed with epilepsy but have not yet been treated as the control group were used to evaluate their emotional behavior problems with the Achenbach children's behavior scale (CBCL, parents). Factor variance analysis and Kruskal-Wallis test were used to compare the general situation of epileptic children, the incidence of abnormal behavior, the score of each factor and the total CBCL score. Results (1) the total detection rate of abnormal behavior in epileptic children was 7.7%, and the detection rates of each group were compared: group LEV (11.5%) TPM (9.1%) new untreated group (7.1%) VPA group (3.4%) healthy children (0), but each of them (0) There was no statistical difference between groups (x ~2=1.344, P0.05). The rate of abnormal behavior in male children (9.1%) was higher than that of female children (2.3%), but the difference was not statistically significant (x ~2=1.873, P0.05). (2) the CBCL scale was based on four different sex and age groups (6-11 years old male and female, 12-16 year old male and female) for the scores of emotional and behavioral factors in each group. Comparison, the results were as follows: (1) the 6-11 year old male epileptic children, in the division like, compulsive aspects: group LEV VPA group TPM new hair group health group; in body complaints, violation of discipline: TPM group VPA group LEV group health group; in depression, bad communication, social withdrawal, hyperactivity, aggression, CBCL total score: TPM group LEV group VPA group new hair group health group. With significant integration group. Study difference (P0.05) for hyperactivity: TPM group was significantly higher than group VPA, new untreated group, health group, and depression, TPM was significantly higher than the new untreated group, healthy group, TPM, VPA were significantly higher than the new untreated group, healthy group; CBCL total score, TPM group was significantly higher than the new untreated group. (2) 6-11 year old female epileptic children, depression, The scores of body complaints were compared: LEV group TPM group VPA group new hair group health group; social withdrawal, hyperactivity, aggression, total score: TPM group LEV group VPA group healthy group; division compulsion: TPM group LEV group new group VPA group healthy group; the significant statistical difference (P0.05) 22 comparison results are as follows: depression, TPM group, LEV group obviously higher than those Group, new hair group, health group, group TPM was obviously higher than group VPA, new untreated group, healthy group, group LEV were obviously higher than that of new untreated group; attack, group TPM, LEV group were obviously higher than that of new untreated group, healthy group; CBCL total score, TPM group was obviously higher than group VPA, new hair group, health group, LEV group was obviously higher than that of new untreated group, healthy group, healthy group. (3) 12-16 year old male epileptic children, the scores of body complaints were compared: group VPA new hair group TPM group LEV health group; split like, bad communication, compulsion, discipline, aggression, CBCL total score: TPM group VPA group LEV group new hair group health group, TPM group malfunction total score is significantly higher than the healthy group (P0.05). Immature aspect: VPA LEV LEV Group TPM healthy group Xin hair group; hostility: group LEV TPM group VPA group new hair group health group; hyperactivity: VPA group LEV group TPM group new hair group health group, among which TPM group malfunction total score was significantly higher than the healthy group. (4) the 12-16 year old female epileptic children, anxiety compulsion, depression and withdrawal, CBCL total score: LEV group VPA group health group; body complaint VPA group, group LEV, group VPA, health group, health group, and CBCL total score were not statistically significant (P0.05). Conclusion (1) 6-11 year old epileptic children taking topiramate as a single drug treated with levetiracetam, valproic acid is more likely to appear hyperactivity, social withdrawal, violation, The incidence of emotional behavior in the 12-16 year old epileptic male children was lower than that of the topiramate group. (2) the incidence of emotional and behavioral problems of 6-11 year old epileptic children treated with levetiracetam was lower than that in the topiramate group, but the schizophrenia in the male children was divided. The incidence of body complaints was higher than that of topiramate. The incidence of epileptic children aged.12-16 years old in the sodium valproate group was relatively lower, mainly manifested by hostility, anxiety, depression and aggression. (3) the possibility of emotional behavior problems of 6-11 year old epileptic children treated with sodium valproate single drug was less likely. The incidence of 12-16 year old age group was relatively increased, mainly manifested by immature, body complaints, hyperactivity, splits and so on. (4) there was no significant difference in the incidence of emotional and behavioral problems between different sex epileptic children.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1

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