丙戊酸钠注射液联合左乙拉西坦治疗难治性癫痫持续状态的临床观察

目的探讨丙戊酸钠注射液联合鼻饲左乙拉西坦治疗难治性癫痫持续状态(RSE)的疗效及安全性。方法对2010年1月—2012年8月连续登记的48例经地西泮静滴、苯巴比妥肌内注射治疗未能控制的RSE患者,其中25例单独使用丙戊酸钠注射液(丙戊酸钠组),23例应用丙戊酸钠注射液联合鼻饲左乙拉西坦(联合治疗组)。两组丙戊酸钠注射液使用方法均首剂为10～15 mg/kg,在3～5 min内静脉注射,而后以0.5～1 mg/(kg.h)持续静脉滴注。联合治疗组中鼻饲左乙拉西坦中位剂量为1 000 mg(范围:500～3 000 mg)。结果丙戊酸钠组总有效率为60.0%,联合治疗组为95.7%,两组比较,差异有统计学意义(P<0.05)。联合治疗组及丙戊酸钠组有效患者均在1 h内癫痫持续状态(SE)得到控制,然而丙戊酸钠组有40%在其后72 h仍间断癫痫发作,而联合治疗组仅4.3%在其后72 h见癫痫发作。两组治疗前后的血、尿常规、肝肾功能、凝血功能、心电图无明显变化。结论丙戊酸钠注射液联合鼻饲左乙拉西坦治疗RSE安全有效,且起效快、作用强、控制时间长。

Combined application of sodium valproate injection and Levetiracetam to treatment of refractory status epilepticus

Objective To discuss the clinically therapeutic effect of combined application of sodium valproate injection and nasogastric administration of Levetiracetam on refractory status epilepticus and its safety.Methods A total of 48 patients with refractory statue epilepticus,whose seizure was not under control after the usage of intravenous diazepam and intramuscular phenobarbital,were enrolled from January 2010 to August 2012.The patients were divided into two groups at random,i.e.trial group(n = 23) and control group(n = 25).The control group was treated with sodium valproate injection 10-15 mg / kg by intravenous bolus injection in the first 3-5 minutes,0.5-1 mg /(kg.h) by intravenous drip for maintenance],and the trial group was treated with Levetiracetam additionally.Levetiracetam was administered via nasogastric feeding at the dosage of 1 000 mg(ranged from 500-3 000 mg).Results The effective rate 60.0% in the control group and 95.7% in the control group,between which there was a significant difference(P < 0.05).All the patients were relieved in the first hour’s treatment.However,relapse rate was only 4.3% in the trial group after 72 hours,while it rose up to 40% in the control group.There were no significant differences in the results of blood and urine routine test,liver and renal function,blood coagulation and EKG between the two groups.Conclusion The combined application of sodium valproate injection and nasogastric administration of Levetiracetam in the treatment of refractory status epilepticus has the advantage of fast and strong effect,long lasting control and high safety.