促肾上腺皮质激素治疗婴儿痉挛55例临床研究

目的 总结首次应用促肾上腺皮质激素(ACTH)治疗婴儿痉挛的临床疗效、不良反应、用药前后的脑电图变化,为ACTH的普及应用提供临床借鉴.方法 对我中心既往3年间收治的首次应用ACTH治疗的婴儿痉挛患儿的临床资料进行回顾性分析.结果 (1)控制痉挛发作显效率为54.7%,好转率为15.1%,无效率为30.2%,且疗效与发病年龄、病程及病因有关;(2)不良反应有睡眠周期改变(85.5%)、皮肤颜色变深(81.8%)、心律不齐(65.5%)、血压升高(38.2%)、低钾血症(21.8%)、感染(20.0%)等;(3)用药前脑电图多以高峰节律紊乱为主要背景,用药两周后脑电图高峰节律消失41例(74.5%),好转14例(25.5%).结论 首次应用ACTH治疗婴儿痉挛疗效肯定,尤其可明显改善患儿高峰节律紊乱脑电背景,用药期间也存在一定的不良反应,应密切观察.

Clinical study of ACTH treatment in 55 children with infantile spasms

Objective To summarize efficacy, adverse effects, the EEG changes of children with infantile spasms before and after ACTH treatment. Methods Clinical datas of children with infantile spasms who accepted ACTH treatment from January 2006 to January 2009 were retrospectively analyzed. Results (1) Spastic attack significantly declined by 54.7% ,improved by 15.1% ,30.2% were invalid,and the efficacy rate was related with onset age, disease course and etiology. (2) Adverse effects were change of sleep cycle (85.5%), skin becoming darker in color (81.8%), arrhythmia (65.5%), hypertension (38.2%), hypokalemia(21.8%), and infection (20.0%). (3) The majority of main EEG background before treatment was hypasarrhythmia,after two weeks of ACTH treatment,the EEG background of hypasarrhythmia disappeared in 41 cases(74.5% ) ,improved in 14 cases(25.5% ). Conclusion The efficacy of ACTH treatment for children with infantile spasms is centain, especially can significantly improve the background of hypasarrhythmia of EEG,during the period of drug use adverse effects maybe appear,which should be closely observed.