丙戊酸钠缓释片联合卡马西平治疗额叶癫痫的效果分析

目的:探讨采用丙戊酸钠缓释片联合卡马西平在额叶癫痫中的应用效果及安全性。方法:选取2014年5月~2015年5月我院收治的额叶癫痫患者80例,随机分为对照组和观察组各40例。对照组给予卡马西平治疗,观察组给予丙戊酸钠缓释片联合卡马西平治疗,比较两组患者治疗效果及不良反应发生情况。结果:观察组患者治疗总有效率显著高于对照组,不良反应发生率低于对照组(P0.05)。结论:丙戊酸钠缓释片联合卡马西平治疗额叶癫痫疗效显著,可明显减少不良反应发生,值得临床推广应用。     

抗癫痫药物治疗对血脂水平影响的研究

目的:探讨长期服用抗癫痫药物(卡马西平、苯妥英钠、丙戊酸钠)对血脂水平的影响。方法:测定已确诊为癫痫的48例患者(卡马西平组16例,苯妥英钠组16例,丙戊酸钠组16例)的血脂水平,并与健康对照组16例进行比较。结果:1)血脂浓度与癫痫本身无相关性;2)长期服用卡马西平和苯妥英钠后总胆固醇(TC)和甘油三酯(TG)、高密度脂蛋白(HDL-c)、载脂蛋白A(Apo-A)和脂蛋白(a)[LP(a)]明显增高(p<0.05),低密度脂蛋白(LDL-c)无变化,且LP(a)随治疗时间的延长浓度明显增高(r=0.74,p<0.05),丙戊酸钠对血脂无影响。结论:长期抗癫痫药治疗能使血脂浓度增高,因此需长期监测血脂水平,预防动脉粥样硬化。     

卡马西平结合丙戊酸钠治疗脑梗塞后继发癫痫的临床综合护理研究

目的:观察卡马西平联合丙戊酸钠治疗脑梗塞后继发癫痫的临床护理。方法:选取我院神经内科2013年1月-2015年6月期间收治的脑梗塞后继发癫痫患者90例随机分成2组,每组45例,均采取卡马西平联合丙戊酸钠治疗;对照组治疗期间行常规护理,观察组给予综合护理干预,对两组患者治疗护理前后GCS及Barthel指数评分、功能评分进行比较。结果:两组治疗后2个月GCS及Barthel指数评分均明显高于治疗前,且观察组GCS及Barthel指数评分明显高于对照组[(11.30±2.55)vs(8.20±1.84),P0.05;(70.45±7.89)vs(54.53±9.21),P0.05]。观察组干预后认识、运动和功能综合评分均明显高于对照组(P0.05)。结论:卡马西平联合丙戊酸钠治疗癫痫,配合综合护理可取得很好的效果。     

癫痫患者服用中药制剂西药成分的血药浓度检测

目的探讨某些抗癫痫"中药制剂"中是否含有抗癫痫西药成分及其含量情况,指导临床用药。方法采用荧光偏振免疫法测定58例癫痫患者所服"中药制剂"中的丙戊酸钠、苯妥英钠、苯巴比妥、卡马西平的种类及血药浓度。结果所有患者中均检测出上述1～4种常用抗癫痫西药。血药平均浓度丙戊酸钠为(12±14)μg/ml,苯妥英钠为(5±6)μg/ml,苯巴比妥为(11±9)μg/ml,卡马西平为(2.2±2.6)μg/ml。结论所谓的抗癫痫"中药制剂"中含有不同种类和剂量的常用化学药物,干扰了癫痫的正规治疗。     

丙戊酸钠联合不同药物治疗癫痫的效果

目的探讨丙戊酸钠联合不同药物治疗癫痫的疗效及预后状况。方法选取采用丙戊酸钠联合不同药物治疗癫痫的300例患者,分析研究病例资料,归纳总结患者的用药情况、治疗效果、用药安全性、产生的不良反应及其相关因素。结果丙戊酸钠联合拉莫三嗪治疗总有效率、丙戊酸钠联合托吡酯治疗总有效率、丙戊酸钠联合左乙拉西坦治疗总有效率、丙戊酸钠联合卡马西平治疗总有效率均显著高于丙戊酸钠单药治疗总有效率(P 0. 05)。丙戊酸钠单药治疗不良反应发生率为19. 72%,丙戊酸钠联合拉莫三嗪治疗不良反应发生率为20. 00%,丙戊酸钠联合托吡酯治疗不良反应发生率为18. 75%,丙戊酸钠联合左乙拉西坦治疗不良反应发生率为21. 43%,丙戊酸钠联合卡马西平治疗不良反应发生率为17. 64%,丙戊酸钠联合用药与丙戊酸钠单药比较差异无统计学意义(P 0. 05)。结论丙戊酸钠联合用药治疗癫痫的疗效显著,不良反应发生情况未增加,年龄小于10岁的儿童是丙戊酸钠不良反应发生的主要人群,神经系统是不良反应发生的主要系统,丙戊酸钠不同联合用药安全性较高,但丙戊酸钠所致的不良反应应引起高度的重视。     

卡马西平联合丙戊酸钠治疗脑炎继发癫痫的效果分析

选取2012年3月~2015年2月我院收治的脑炎继发癫痫患者27例,随机分为A、B和C组各9例。A组给予卡马西平联合丙戊酸钠治疗,B组给予单纯卡马西平治疗,C组给予单纯丙戊酸钠治疗。比较三组患者的临床疗效及不良反应发生率。A组临床疗效明显高于B、C组,A组与B组、A组与C组比较差异均具有统计学意义(P<0.05);B组与C组临床疗效比较差异无统计学意义(P>0.05)。三组患者不良反应发生率比较差异无统计学意义(P>0.05)。卡马西平联合丙戊酸钠治疗脑炎继发癫痫的临床效果显著,不良反应少,值得临床推广应用。     

探讨神经内科应用丙戊酸钠治疗癫痫的临床效果

目的探讨神经内科应用丙戊酸钠治疗癫痫的临床效果。方法选取2014-12—2015-12在大连市第二人民医院神经内科就诊的74例癫痫患者为研究对象。随机分为观察组(37例)和对照组(37例),其中对照组37例患者采用卡马西平进行治疗,观察组37例患者采用丙戊酸钠治疗,观察两组患者治疗效果及不良反应发生情况。结果观察组患者经过1个月治疗后的总有效率与对照组相比好于对照组。两组患者不良反应发生率对比,观察组患者出现胃肠道反应、嗜睡、体质下降症状患者均少于对照组,观察组不良反应发生率低于对照组。结论丙戊酸钠治疗癫痫患者的疗效好、不良反应发生率低,具有安全性高、临床效果好等特点。     

小剂量丙戊酸联合奥卡西平治疗老年癫痫46例疗效分析

目的分析小剂量丙戊酸联合奥卡西平对老年癫痫患者的疗效。方法选取92例老年癫痫患者,根据不同治疗方案将其纳入奥卡西平组(46例)与丙戊酸+奥卡西平组(46例)。奥卡西平组予以奥卡西平治疗,丙戊酸+奥卡西平组予以小剂量丙戊酸联合奥卡西平治疗。对比两组患者的癫痫发作情况(发作次数、发作持续时间)、临床疗效、脑电图变化(痫样放电、累及导联数)、脑电图改善效果。结果丙戊酸+奥卡西平组的癫痫发作次数与发作持续时间[(0.45±0.17)次/月、(1.21±0.56)分钟/次]均少于奥卡西平组[(0.86±0.33)次/月,(2.25±0.84)分钟/次)],P<0.05;丙戊酸+奥卡西平组的总有效率(93.48%)高于奥卡西平组(78.26%),P<0.05;丙戊酸+奥卡西平组治疗后脑电图的痫样放电与累及导联数[(7.38±1.43) t/180 s、(3.45±1.29)/180s]均优于奥卡西平组[(10.20±2.16) t/180s、(5.50±1.52)/180s,P<0.05];丙戊酸+奥卡西平组的脑电图总改善率(91.30%)高于奥卡西平组(73.91%),P<0.05。结论小剂量丙戊酸联合奥卡西平对老年癫痫患者的疗效显著,可明显减少癫痫发作次数与发作持续时间。     

托吡酯、丙戊酸钠、卡马西平治疗脑炎后癫痫的临床疗效比较

选取2008年3月～2013年3月我院收治确诊为脑炎后癫痫的患者48例,所有患者均符合癫痫的诊断标准,随机分为三组,各16例。其中观察组1采用卡马西平治疗癫痫,观察组2采用丙戊酸钠治疗癫痫,观察组3采用托吡酯治疗癫痫,服药后观察患者临床症状的改善和不良反应。结果三组组间有效治疗率对比,没有统计学差异（P〉0.05）。三组的不良反应率为37.5%、25.2%、12.6%,三组组间对比具有统计学差异（P〈0.05）,其中托吡酯的不良反应率最低。托吡酯、丙戊酸钠、卡马西平都能够有效治疗脑炎后癫痫,其中托吡酯治疗癫痫后,患者的不良反应率最低。     

卡马西平与丙戊酸钠对癫癎患儿骨代谢影响的比较

目的:比较两种抗癫癎药物卡马西平和丙戊酸钠对癫癎患儿骨代谢的影响.方法:诊断明确且长期服用卡马西平(28例)或丙戊酸钠(31例)单药治疗半年以上的癫癎患儿,治疗前后采用双能X线吸收法测定腰椎(L2～L4)的骨矿密度,全自动生化分析仪检测血清钙、磷和碱性磷酸酶水平,并进行比较.结果:经抗癫癎治疗6个月后,卡马西平组血清钙、磷水平和骨矿密度均低于丙戊酸钠组;碱性磷酸酶水平则高于丙戊酸钠组(P＜0.01).结论:长期服用卡马西平对癫癎患儿骨代谢的影响比丙戊酸钠明显.为保证患儿的正常生长发育不受影响,在抗癫癎治疗期间应该定期监测骨代谢状况,给予适当的干预以预防代谢性骨病.     

A comparative study of the relative effects of anticonvulsant drugs and dietary folate on the red cell folate status of patients with epilepsy

In a survey of the red cell folate status of 200 patients with epilepsy, compared to 72 controls, we found that median red cell folate levels were reduced significantly in patients treated with phenytoin (p less than 0.01) or carbamazepine (p less than 0.001) alone. Patients taking more than one drug had reduced levels also (p less than 0.001), but in patients treated with sodium valproate alone there was no significant decrease in red cell folate levels compared to controls. Twenty-two per cent of patients in the group taking more than one drug had reduced levels of red cell folate compared with 17 per cent of those taking carbamazepine alone, 13 per cent of those taking phenytoin only, and 9 per cent of those taking sodium valproate only. Dietary folate intake was significantly reduced in all the patient groups compared with controls (p less than 0.001 for the carbamazepine and phenytoin groups, p less than 0.01 for the polypharmacy and sodium valproate groups); a significant correlation between red cell folate levels and dietary folate was not established. Significant negative relationships were established between carbamazepine dose (r = -0.35, p less than 0.01) or serum level (r = -0.27, p less than 0.05) and red cell folate level in patients on one drug only. The correlation between dose or serum level of phenytoin and red cell folate level was also negative but did not reach significance. Our findings show that all anticonvulsant drugs interfere with folate metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)     

A comparative study of the relative influence of different anticonvulsant drugs, UV exposure and diet on vitamin D and calcium metabolism in out-patients with epilepsy

The biochemical parameters associated with vitamin D metabolism, calcium, 25-hydroxy-vitamin D (25OHD) and alkaline phosphatase levels were assessed in 226 out-patients with epilepsy. Patients were grouped depending on the drug treatment; carbamazepine, phenytoin, phenobarbitone and sodium valproate used alone as monotherapy and a combination of these drugs as polytherapy. The most severe alterations occurred in the polytherapy group. Hypocalcaemia was more severe in the phenobarbitone monotherapy group than the carbamazepine or the phenytoin groups. No patient on sodium valproate monotherapy had subnormal levels of calcium (less than 2.1 mmol/l). 25OHD levels were similarly reduced in the carbamazepine, phenytoin and the phenobarbitone groups with no reduction in the sodium valproate group. Significant elevations in alkaline phosphatase levels were evident in all patient groups except the sodium valproate group. This study confirms biochemical evidence for anticonvulsant osteomalacia when the enzyme-inducing drugs are used, the degree of severity depending on the drug regimen.     

A Comparative Study of the Relative Influence of Different Anticonvulsant Drugs, UV Exposure and Diet on Vitamin D and Calcium Metabolism in Out-Patients with Epilepsy

The biochemical parameters associated with vitamin D metabolism,calcium, 25-hydroxyvitamin D (25OHD) and alkaline phosphataselevels were assessed in 226 out-patients with epilepsy. Patientswere grouped depending on the drug treatment; carbamazepine,phenytoin, phenobarbitone and sodium valproate used alone asmonotherapy and a combination of these drugs as polytherapy.The most severe alterations occurred in the polytherapy group.Hypocalcaemia was more severe in the phenobarbitone monotherapygroup than the carbamazepine or the phenytoin groups. No patienton sodium valproate monotherapy had subnormal levels of calcium(<2.1 mmol/l). 25OHD) levels were similarly reduced in thecarbamazepine, phenytoin and the phenobarbitone groups withno reduction in the sodium valproate group. Significant elevationsin alkaline phosphatase levels were evident in all patient groupsexcept the sodium valproate group. This study confirms biochemicalevidence for anticonvulsant osteomalacia when the enzyme-inducingdrugs are used, the degree of severity depending on the drugregimen.     

A Comparative Study of the Relative Effects of Anticonvulsant Drugs and Dietary Folate on the Red Cell Folate Status of Patients with Epilepsy

In a survey of the red cell folate status of 200 patients withepilepsy, compared to 72 controls, we found that median redcell folate levels were reduced significantly in patients treatedwith phenytoin (p<0.01) or carbamazepine (p<0.001) alone.Patients taking more than one drug had reduced levels also (p<0.001),but in patients treated with sodium valproate alone there wasno significant decrease in red cell folate levels compared tocontrols. Twenty-two per cent of patients in the group takingmore than one drug had reduced levels of red cell folate comparedwith 17 per cent of those taking carbamazepine alone, 13 percent of those taking phenytoin only, and 9 per cent of thosetaking sodium valproate only. Dietary folate intake was significantlyreduced in all the patient groups compared with controls (p<0.001for the carbamazepine and phenytoin groups, p<0.01 for thepolypharmacy and sodium valproate groups); a significant correlation,between red cell folate levels and dietary folate was not established. Significant negative relationships were established betweencarbamazepine dose (r=0.35, p<0.01) or serum level (r=-0.27,p<0.05) and red cell folate level in patients on one drugonly. The correlation between dose or serum level-of phenytoinand red cell folate level was also negative but did not reachsignificance. Our findings show that all anticonvulsant drugs interfere withfolate metabolism. While the effect is greatest with drugs whichinduce microsomal liver enzymes, low levels of folate also occurredin patients taking the non-enzyme inducer sodium valproate.Although a significant relationship between diet and red cellfolate was not established, dietary folate could be a furthercontributory factor.     

远程预处理对兔脊髓缺血再灌注损伤的保护作用(英文)

目的:探讨远程预处理对兔脊髓缺血再灌注损伤的保护作用。方法:20只成年雄性新西兰大白兔随机分成2组(各组n=10),即对照组和远程预处理(RPC)组。所有动物脊髓缺血前1h戊巴比妥钠麻醉动物(30mg/kg,iv)。RPC组动物麻醉后进行双后肢短暂缺血2次(充气式压力止血带环扎双后肢,压力26.6kPa,阻断10min,松开10min,再阻断10min),最后一次缺血后再灌注30min,阻闭肾下腹主动脉20min,制作兔脊髓缺血模型。对照组动物不进行双后肢短暂缺血,其余同RPC组。再灌注后4,8,12,24和48h分别对动物后肢运动功能评分。再灌注48h后,处死动物取脊髓(L5～7),石蜡包埋切片行组织病理学观察。结果:RPC组神经功能评分在各时间点均明显高于对照组(P=0.000);与对照组相比,RPC组脊髓前角正常神经细胞数明显增多(P=0.000),且神经功能评分与脊髓前角正常神经细胞计数之间有显著相关性(r=0.868,P<0.01)。结论:远程预处理对兔脊髓缺血再灌注损伤有显著的保护作用。     

目标指导下治疗脓毒性休克的疗效观察

目的对比观察目标指导下脓毒性休克的治疗和传统经验治疗对息者预后的影响。方法采用随机、对照的方法对脓毒性休克患者进行目标指导下的治疗，目标：①中心静脉压（CVP）8～12mmHg（1mmHg=0．133kPa）；②平均动脉压（MAP）≥65mmHg；③上腔静脉血氧饱和度（SvO2）〉0．70；④尿量≥0．5ml／min。同时与经验性指导治疗的患者进行对比。观察两组患者人院后6、24和48hMAP、CVP、动脉血气分析、上腔静脉血气分析、静脉血乳酸含量、心脏每搏量、心排血指数、液体总量、血管活性药物总量、受损器官数目、呼吸机使用例数及7d和14d病死率。结果目标指导治疗组在较短时间内即可纠正休克和组织缺氧状态，24h和48h动脉血氧饱和度（SaO2）、SvO2、MAP、CVP较经验治疗组明显增高（P〈0．05或P〈0．01），乳酸含量降低（P〈0．01），经静脉输入的液体总量较多（P〈0．01），而血管活性药物应用较少（P〈0．01）；48hSaO2、SvO2、MAP、CVP的改善更加显著，受损器官数目少，程度较经验治疗组轻；7d及14d的病死率目标指导治疗组也较经验治疗组低（P〈0．05）。结论目标指导治疗脓毒性休克与经验治疗组相比可明显改善休克的预后。     

Douleur et antiépileptiques. Aspects cliniques

Résumé  Les antiépileptiques sont couramment utilisés dans le traitement de la douleur. Ils incluent désormais, à c?té des antiépileptiques courants (carbamazépine, phényto?ne, clonazépam, valproate de sodium), les nouveaux antiépileptiques, notamment la gabapentine et la lamotrigine. Leur efficacité a été confirmée sur la base d’essais randomisés, contr?lés versus placebo, dans la névralgie du trijumeau (carbamazépine: 3 études, lamotrigine: 1 étude), les douleurs neuropathiques du diabète (gabapentine: 1 étude, à moindre degré carbamazépine: 1 petite étude et phényto?ne: 3 études dont une négative), l’algie post-zostérienne pour la gabapentine (1 étude) et le traitement de fond de la migraine (valproate de sodium: 4 études, carbamazépine et gabapentine: 1 étude chacun). La carbamazépine reste le traitement de première intention de la névralgie du trijumeau et le valproate est l’antiépileptique de référence dans le traitement de fond de la migraine. Les nouveaux antiépileptiques, généralement bien tolérés, devraient conna?tre une utilisation de plus en plus large dans diverses douleurs neuropathiques.

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Summary  Anticonvulsants are currently used for the treatment of pain. They now include current antiepileptics (carbamazepine, phenytoin, clonazepam, sodium valproate), and newer antiepileptics, notably gabapentin and lamotrigin. Their efficacy has been demonstrated in randomized placebo controlled trials in trigeminal neuralgia (carbamazepine: 4 trials, lamotrigine: 1 trial), diabetic neuropathic pain (gabapentin: 1 trial, to a lesser extent carbamazepine: 1 small trial, and phenytoin: 3 trials including one negative), postherpetic neuralgia for gabapentin (1 trial), and the prophylactic treatment of migraine (sodium valproate: 4 trials, carbamazepine and gabapentin: one trial each). Carbamazepine is still used as fist line therapy of trigeminal neuralgia and valproate is considered the best antiepileptic for the prophylactic treatment of migraine. Newer antiepileptics, generally well tolerated, may also represent in the future a treatment of choice for various neuropathic pain states.

Texte présenté d’un cours de perfectionnement, intitulé ?Douleur et Canaux loniques? qui s’est tenu dans le cadre de la 22^e réunion annuelle de la SFD, le 19 novembre 1998 à Versailles.     

白细胞介素-1受体拮抗剂对新生鼠窒息后肾损伤保护作用的动态研究

目的 观察重组人白细胞介素-1受体拮抗剂（rhIL-1ra）对窒息后肾损伤的保护作用及其机制。方法 检测对照组及rhIL-1ra（＋rhIL-1ra组）或生理盐水（＋NS组）处理新生鼠窒息后复氧2、24和48h肾组织炎症反应及肾损伤指标的变化。结果 与对照组（13只）比较，窒息后复氧2h（10只）、24h（11只）、48h（10只）＋NS组的白细胞数（WBC）、白细胞介素-1（IL-1）、IL-8、IL-6、一氧化氮（NO）、内皮素-1（ET-1）、左肾系数（LRC）、肾小管损伤评分均升高，差异均有显著性（P〈0．05或P〈0．01）。与窒息后复氧＋NS组比较，窒息后复氧2h（10只）、24h（10只）、48h（11只）＋rhIL-1ra组上述指标除IL-6外均降低，差异也均有显著性（P〈0．05或P〈0．01）；而窒息后复氧24h、48h＋rhIL-1ra组IL-6均降低，差异均有显著性（P〈0．05或P〈0．01）。结论 rhIL-1ra对窒息后肾损伤具有保护作用，其机制可能与抑制窒息后肾组织炎症反应有关。     

罗痛定对脑缺血/再灌注损伤大鼠器官组织一氧化氮合酶的影响

目的观察大鼠脑缺血/再灌注（I/R）损伤不同阶段肺、肝、肾组织一氧化氮合酶（NOS）的活性变化,探讨罗痛定的作用机制。方法选择76只SD大鼠,按改良的四血管阻塞法建立脑I/R损伤模型。随机分为假手术组、I/R损伤组和罗痛定治疗组,后两组分别于再灌注2、6、12、24和48h处死大鼠,测定肺、肝、肾组织不同类型NOS活性。结果I/R损伤组总NOS（tNOS）活性于再灌注2、12和24h均较假手术组显著升高（P〈0.05或P〈0.01）,尤以12h时上升最显著（P均〈0.01）;2h时以结构型NOS（cNOS）活性上升为主（P均〈0.05）;12h时以诱生型NOS（iNOS）活性上升为主（P均〈0.01）,至24h仍较高（P均〈0.05）,48h时基本接近假手术组水平。与I/R损伤组比较,罗痛定治疗组各组织cNOS活性在2h时上升更显著（P均〈0.05）,iNOS在12h以后明显下降（P〈0.05或P〈0.01）。结论在脑I/R损伤不同阶段肺、肝、肾组织中不同类型NOS活性不同,发挥作用不同;罗痛定可以通过调节不同类型NOS活性减轻组织损伤。