【摘要】：目的:觀察丙戊酸鈉聯(lián)合左乙拉西坦治療腦卒中后癲癇的療效和安全性。方法:84例腦卒中后癲癇患者隨機(jī)分為對(duì)照組(42例)和觀察組(42例)。兩組患者均給予降血脂、降血壓、改善微循環(huán)、降低顱內(nèi)壓、抗凝、抗血小板聚集及腦神經(jīng)保護(hù)藥等常規(guī)治療,對(duì)于癲癇持續(xù)狀態(tài)患者酌情給予地西泮控制癥狀。在此基礎(chǔ)上,對(duì)照組患者口服丙戊酸鈉緩釋片15~20 mg/(kg·d),每日3次,連用7 d,若癥狀得到控制則維持此劑量;若癥狀未得到控制則增加劑量至20~30 mg/(kg·d),每日3次。觀察組患者在對(duì)照組治療的基礎(chǔ)上口服左乙拉西坦片初始劑量0.25 g,每日2次,連用7 d后增加劑量至0.5 g,每日2次,若癥狀得到控制則維持此劑量;若癥狀未得到控制則增加劑量至3 g,每日2次。兩組患者均連續(xù)用藥12個(gè)月,后每周減少左乙拉西坦片0.25 g至完全停藥,對(duì)于停藥后復(fù)發(fā)者需終身用藥。觀察兩組患者的臨床療效、治療前后癲癇發(fā)作次數(shù)、發(fā)作持續(xù)時(shí)間、癇樣放電、累及導(dǎo)聯(lián)數(shù)、神經(jīng)元特異性烯醇化酶(NSE)、腫瘤壞死因子(TNF)-α、白細(xì)胞介素(IL)-2、IL-6水平及不良反應(yīng)發(fā)生情況。結(jié)果:觀察組患者總有效率顯著高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療前,兩組患者癲癇發(fā)作次數(shù)、發(fā)作持續(xù)時(shí)間、癇樣放電、累及導(dǎo)聯(lián)數(shù)、NSE、TNF-α、IL-2、IL-6水平比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后,兩組患者癲癇發(fā)作次數(shù)、發(fā)作持續(xù)時(shí)間、癇樣放電、累及導(dǎo)聯(lián)數(shù)、NSE、TNF-α、IL-2、IL-6水平均顯著低于同組治療前,且觀察組低于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者不良反應(yīng)發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:在常規(guī)治療的基礎(chǔ)上,丙戊酸鈉聯(lián)合左乙拉西坦治療腦卒中后癲癇的療效顯著優(yōu)于單用丙戊酸鈉,且不增加不良反應(yīng)的發(fā)生。
[Abstract]:Objective: to observe the efficacy and safety of sodium valproate combined with levetiracetam in the treatment of post-stroke epilepsy. Methods: 84 patients with post-stroke seizures were randomly divided into control group (n = 42) and observation group (n = 42). The patients in both groups were given routine treatment such as lowering blood lipid, lowering blood pressure, improving microcirculation, reducing intracranial pressure, anticoagulation, antiplatelet aggregation and cerebral neuroprotective drugs, and diazepam was given diazepam as appropriate to control the symptoms. On this basis, the patients in the control group were given sodium valproate sustained-release tablets 15 鈮，

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