新型抗癫痫药对癫痫患者认知功能的影响

癫痫患者认知障碍发生率较高,约44%的患者有学习困难、45%的患者有思维迟钝、63%的患者认为癫痫阻碍了他们取得成功或妨碍他们达到既定的生活目标。癫痫患者认知障碍可能由多种因素造成,主要包括痫性发作、发作间期的异常放电、基础的     

抗癫痫药对癫痫患者骨密度的影响

目的:探讨抗癫痫药对癫痫患者骨密度(BMD)的影响.方法:对56例成年患者进行检查和随访,并作BMD测定.结果:56例中BMD正常者占55.4%(31例)、骨质疏松者占10.7%(6例),骨量减少者占33.9%(19例);BMD降低以腰椎明显,尤以腰1最显著,腰1和腰2～4的Z分值分别为-0.66±0.89和-0.4±0.98;多药比单药治疗更易引起BMD降低,两者间有显著差异(P＜0.05);酶诱导剂组和非酶诱导剂组间差异不显著(P＞0.05);BMD改变与服药时间有显著相关性,其余因素则无显著影响.结论:长期使用抗癫痫药是引起BMD降低的重要危险因素,单药治疗比多药治疗对BMD影响小,BMD降低以腰椎最为明显.     

女性癫痫患者妊娠期抗癫痫药物药动学变化及应对措施

癫痫是一种以反复痫性发作为主要特征的慢性神经系统疾病,患者通常需要长期服药。妊娠期伴随的药物分布容积增加、肾血流量增加、肝脏代谢的诱导、激素水平的改变和血清蛋白浓度降低等特殊的生理状态可影响抗癫痫药的吸收、分布、代谢和清除,导致患者妊娠期癫痫发作频率增加,加大了诊疗难度。因此,如何在避免抗癫痫药相关不良妊娠结局和不良反应的同时有效控制妊娠期癫痫发作,是一个亟需解决的问题。基于此背景,本综述概括了常用抗癫痫药在妊娠期的血药浓度和（或）清除率变化及妊娠期可能影响药物代谢的因素,建议对服用拉莫三嗪、左乙拉西坦或奥卡西平的妊娠期癫痫女性患者进行常规的治疗药物监测;必要时,也可对服用托吡酯和唑尼沙胺的妊娠期癫痫女性患者进行治疗药物监测;从安全性考虑可对服用丙戊酸、卡马西平的妊娠期癫痫女性患者进行治疗药物监测。然而,目前尚需要更多高质量研究为妊娠期女性癫痫患者的用药管理提供证据。     

三种抗癫痫药对癫痫患者脑电图的背景影响比较研究

目的 :观察比较苯妥因钠 (PHT)、丙戊酸钠 (SVP)和卡马西平 (CBZ)三种抗癫痫药物在治疗癫痫过程中对脑电图(EEG)的背景影响。方法 :对 76例临床确诊为癫痫、EEG检查有痫样波放电的病人按照用药分成 PHT组 2 6例 ,SVP组 2 7例 ,CBZ组 2 3例 ,动态观察各组在服药期间痫样波放电的频度和 EEG背景的变化。结果 :SVP组对 EEG痫样波放电的抑制率明显优于 PHT和 CBZ,对 EEG背景活动影响最明显的是 CBZ,服用 CBZ两周后α波即开始变慢 ,三周后慢波明显增多 ,这种变化与临床疗效不呈一致。结论 :三种药物对 EEG背景活动影响的程度顺序是 CBZ>PHT>SVP,开始时间是服药后 2周 ,而对痫样波放电的抑制率是 SVP>PHT>CBZ     

癫痫患者口服抗癫痫药治疗与护理

癫痫是一种以大脑神经元异常放电引发突然、短暂且反复发作的,以意识障碍、抽搐、知觉障碍、感觉异常导至精神、行为、情感以及内脏功能紊乱为基本特征的综合征。目前我国的发病率为0.5%～0.7%,它严重危害着人体的健康,对患者的智力、大脑发育及生活质量有不同程度的影响。由于在治疗上与其它疾病不同,不单凭医生开处方,患者服药就能治愈,而需医患共同努力,从整体着手,才能有希望达到理想的治疗效果。     

抗癫痫药物鼻腔给药治疗癫痫发作研究进展

以全身疾病为治疗目的的鼻腔给药具有相对生物利用度高、吸收迅速、起效快、使用方便等特点,而且药物可以绕过血脑屏障、具有一定的脑靶向性,非常适合于癫痫发作的急救、自救治疗。笔者就抗癫痫药物鼻腔给药治疗癫痫发作的研究进展,从药物动力学、药效学、临床应用等方面进行综述。     

应用不同抗癫痫药治疗儿童癫痫与肥胖的关系

目的　了解应用不同抗癫痫药 (AEDs)所导致癫痫患儿肥胖的情况。方法　根据患儿服用的不同AEDs,将 6 6例癫痫病人分为丙戊酸钠治疗组和非丙戊酸钠治疗组两组 ,对其体重 (Wt)及身高 (H)从服用AEDs开始进行为期 6个月的观察 ,观察肥胖指标 (BMI)的变化情况。结果　丙戊酸钠治疗组从治疗后 3个月开始出现肥胖 ,到治疗后 6个月时 ,男、女性的肥胖指标才有统计学的差异 ;丙戊酸钠治疗组的肥胖指标与非丙戊酸钠治疗组的统计学差异 ,也是从治疗后 3个月开始。结论　应用丙戊酸钠后可导致癫痫病人出现肥胖 ,其肥胖发生的时间一般在开始应用此药治疗后 3个月 ,因此 ,临床上应用丙戊酸钠时 ,要注意导致癫痫病人出现肥胖的问题。     

抗癫痫药的研究进展

本文综述了欧美国家近１０年来应用于临床的抗癫痫药在体内吸收，分布，排泄的方式，相互间的作用及适用癫痫的类型，临床上抗癫痫药的选择原则。对于抗癫痫药耐受癫痫，药物开发重点应集中于压制神经元高兴奋性及阻止原发灶的进一步传播。     

局灶性癫痫患者停用抗癫痫药后的复发风险研究

目的：评估停用抗癫痫药(AED)后成年患者局灶性癫痫复发的风险和复发的高危期,分析影响停药2年内的复发风险及相关危险因素,确定无癫痫发作2年以上的患者停药后复发的预测因素,以期为临床合理用药提供更多依据。方法：利用癫痫随访登记数据库,对2015年1月至2020年1月该院收治的108例成年局灶性癫痫患者进行随访。用Kaplan-Meier法分析复发风险和复发时间,用Cox比例风险回归模型确定预测因素。结果：108例患者中,39例出现了复发,其中8例在药物减停过程中发生,31例在完全停药之后出现。Kaplan-Meier生存曲线显示,AED停药后12、24、36、48、60、72和84个月的癫痫复发概率分别为24.0%、20.4%、8.3%、2.7%、4.6%、0.97%和0.98%。大部分复发发生于停药24个月内,尤其是停药12个月内。停药24个月后,癫痫复发的可能性下降,尤其是停药60个月后,癫痫复发率<1%,呈极低的水平曲线,仅2例患者分别在停药64个月和84个月时复发。此外,AED停药12、24、36、48和60个月癫痫复发的累积概率分别为24.0%、41.3%、48.4%、...     

流动人口已婚育龄妇女生殖道感染自我报道症状的调查

目的了解已婚流动人口育龄妇女生殖道发生感染症状的情况并分析其影响因素,为制定相关健康教育策略提供依据。方法选择在我单位定期查病、查孕、查环的已婚流动人口育龄妇女,按照不同省份来源随机抽取1054人作为研究对象,利用SPSS11.5统计软件对资料进行分析。结果调查对象平均年龄为(29.01±4.45)岁,以初中文化为主,职业以工人为主,主要来自湖南、河南和四川等省份。在调查对象中52.8%的人最近一年有过一种或一种以上生殖道自我报告的症状,其发生率由高到低分别为白带异常(38.0%)、非月经期腰背酸痛(31.9%)、外阴瘙痒(15.8%)、尿频尿痛(6.8%)、生殖器溃疡(2.8%),既往流产、妇科病/性病、盆浴、便后向前擦纸和经期性生活是生殖道感染症状发生的危险因素,OR值分别为1.8、31.6、1.44、3.17和3.57。结论应通过定期检查,早发现、早诊断、早治疗来降低妇女生殖道感染发生率,同时促进她们自我保健的意识和需求。     

Serum concentrations of p, p'-DDE, HCB, PCBs and reproductive hormones among men of reproductive age

Exposure to polychlorinated biphenyls (PCBs) has been associated with changes in reproductive hormone levels, however most groups studied have been highly exposed. We investigated the association of PCBs, hexachlorobenzene (HCB) and p, p'-DDE with serum sex hormones in 341 adult men from a US infertility clinic with exposure levels consistent with those observed in the general population. In crude regression models we observed several negative associations of PCBs and HCB with steroid hormone-binding globulin (SHBG) and total and free testosterone. After adjustment for lipids, age and BMI, nearly all significant associations were attenuated. A negative relationship remained between PCB 118 and SHBG (p<0.01), and relationships of dioxin-like PCBs with SHBG and total testosterone, and between PCB 118 and total testosterone, were suggestive. These results suggest a minimal relationship between PCB exposures at low background levels similar to those observed in the general population of the US and circulating reproductive hormones.     

育龄妇女使用宫内节育器的不良反应发生状况研究

目的：探讨育龄妇女使用宫内节育器的不良反应发生状况,为控制其不良反应的发生提供参考。方法对本中心800例使用宫内节育器育龄妇女的不良反应情况及宫内节育器类型等进行调查与记录,并行统计分析。结果共344例妇女出现不良反应,不良反应发生率为43.00%,且不同类型的宫内节育器不良反应发生率差异有统计学意义（P＜0.05）。使用T型环和宫型/元宫花环发生不良反应的危险分别是吉妮环的3.21倍、3.01倍,差异有统计学意义（P＜0.05）。结论宫内节育器的不良反应发生率较高,且不同类型的宫内节育器不良反应存在差异,应加强不良反应的防治。     

Determinants of reproductive tract infections among asymptomatic women in Harare, Zimbabwe

OBJECTIVES: To determine the prevalence of and risk factors for reproductive tract infections (RTI) among asymptomatic women attending primary health care clinics in Harare, Zimbabwe. DESIGN: A cross sectional study. MAIN OUTCOME MEASURES: Prevalent RTI, HIV and socio-demographic data. SETTING: Two primary health care clinics in Harare. SUBJECTS: 393 consecutive, consenting women aged 15 to 49 years, presenting at the clinics for antenatal care, family planning, or bringing their children to attend preventive care clinics. RESULTS: More than half of the women had at least one ongoing RTI. Voluntary reporting of symptoms was almost non-existent. Prevalence of HIV was 29.3% and that of classical STIs was 15.4% Trichomoniasis vaginalis, 3.9% syphilis, 3.9% Chlamydia trachomatis and 1.8% Neisseria gonorrhoea. Bacteria vaginosis was diagnosed in 30.3% of the women and candidiasis in 25.4%. Presence of any RTI was significantly associated with lower level of education, sexual debut < 20 years, a non-monogamous partner, and use of a condom during the last sexual encounter. Independent factors associated with cervical infections were young age (< 20 years), being unmarried, current dysuria, warts, clinical signs of purulent or yellowish discharge, lower abdominal pain and cervical friability. Vaginitis was associated with sexual debut or marriage < 20 years, a partner who was a frequent traveller, history of STI, and presence of abnormal vaginal discharge. CONCLUSION: In view of the high prevalence of RTI and HIV and the low reporting of symptoms by infected women, it is recommended that strategies that improve women's awareness of urogenital symptoms be adopted, along with pro-active inquiry of genital symptoms by the health care workers, and treatment of RTIs, in order to reduce the unnecessary burden of RTIs.     

韶关市育龄妇女优生优育相关知识的知晓情况及需求分析

目的对韶关市育龄妇女优生优育相关知识的知晓情况及需求展开调查分析,从而为当地优生优育提供参考和借鉴。方法选择2014年1月~2015年3月韶关市育龄妇女503例作为研究对象,结合问卷、当面询问的方式调查,调查研究对象的一般资料,调查研究对象对优生优育相关知识的需求情况,了解研究对象对优生优育知识的知晓情况,同时比较不同收入、文化水平、地区育龄女性对优生优育知识的知晓情况。结果发放503份调查问卷共收回477份,有效回收率为94.8%。97.9%的研究对象对优生优育知识有强烈的需求。研究对象对优生优育知识的知晓情况并不理想,知晓率大多数在50.0%左右,对部分知识的知晓率甚至在20%左右。收入情况、文化水平、居住地区对育龄女性对优生优育知识的知晓情况一定程度的影响,不同收入情况、文化水平、居住地区育龄女性对优生优育知识的知晓情况是存在差异的,差异具有统计学意义(P0.05)。结论虽然韶关市大多数育龄妇女对优生优育知识有强烈的需求,但是目前对优生优育相关知识的知晓情况并不理想,需要加强对育龄妇女的宣传力度、做好优生优育相关的咨询工作。     

Factors related to medication adherence among homeless women and children

Objective The primary objective of this study was to examine factors related to medication adherence among homeless women and children. A secondary purpose was to describe the medication informational needs of homeless women. Method Fifty‐seven women at six different shelters for homeless women in Wake County, North Carolina were interviewed during the summer of 2001. Key findings Fifty‐eight per cent of women reported having at least one medical condition and 84% of the women had taken at least one medication during the past week. Twenty‐six per cent of women said that during the last week they had not taken a medication on purpose and 30% purposively cut back on a medication. A woman with a substance abuse problem was five times more likely to purposively not take a medication. Almost half of the women who had children living with them had a child that had taken medication during the past week. The primary reasons cited for not using medications as directed were access issues. Fifty‐eight per cent of the women wanted to learn more about their or their children's medications. The majority of women preferred to receive more verbal and written drug information. Conclusions Pharmacists need to work with local homeless shelters and the women in these shelters to help make sure that they receive needed medications and information for themselves and their children.     

Relative concentrations of organochlorines in adipose tissue and serum among reproductive age women

Much of the available literature focusing on organochlorine exposure and human health effects has relied upon serum for quantifying exposure despite adipose tissue being the purported "gold standard". The accuracy of exposure status is dependent upon serum being a valid and reliable proxy for adipose tissue regardless of compound under study and served as the impetus for study. Serum and omentum fat concentrations for 62 polychlorinated biphenyls (PCBs) and 7 organochlorine pesticides (OCPs) were determined using gas chromatography with electron capture and compared to assess their relative abundance and correlation among 15 women aged 18-40 years undergoing laparoscopy. The relation between concentration in serum and fat was determined by linear regression. Of the 20 organochlorines (OCs) (29%) present in both serum and fat samples, moderate linear correlations (r > 0.6) were observed between lipid-adjusted serum and fat concentrations for PCBs #138, 153, 180, 188, 194, 206, and DDE. Forty-nine OCs were present in adipose samples but measured below the LOD in serum samples. Our findings underscore the potential for discrepant human health results associated with OC exposure on the basis of medium used for quantification purposes, especially for less ubiquitous compounds or when study samples include individuals with relatively low exposures. These data support earlier findings and argue for concerted methodological work aimed at developing standardized laboratory methods for epidemiologic studies.     

有不良孕产史孕妇的生活质量和心理调查

目的比较有、无不良孕产史孕妇的生活质量以及焦虑、抑郁等症状,以了解不良孕产史对妇女生活的影响。方法在围保门诊对300名妊娠18～24周的孕妇进行调查,其中150名有不良孕产史(A组),150名无不良孕产史(B组),详细询问每人的社会人口学特征,并让孕妇自填SF-36量表和医院焦虑抑郁量表。结果 A组孕妇生活质量调查表各项得分均低于B组,焦虑、抑郁发生率高于B组,差异有极显著意义。结论有不良孕产史的妇女再次妊娠期间容易出现焦虑、抑郁症状,生活质量明显下降。     

抗癫痫药物及其他危险因素对妊娠癫痫妇女及胎儿的影响

目的 对抗癫痫药物及其他危险因素对妊娠癫痫妇女及胎儿的影响进行前瞻性研究。方法 （1）癫痫妇女孕早期或妊娠前咨询入组。（2）孕期主要观察指标：对高危患者进行检查,包括血浆中AFP的水平、染色体检查、羊水穿刺细胞学及分子生物学检查、分子遗传分析、B超等。（3）畸形的确认：根据国际疾病控制中心编写的严重先天性缺陷一览表（1998年修订）。（4）危险因素分析：妊娠年龄、畸形的家族史、吸烟、饮酒、单用或联用抗癫痫药物、抗癫痫药物剂量、癫痫的分型、妊娠前3月内癫痫发作频率等。结果 共入组57例妊娠癫痫妇女,共有41例 妊娠癫痫妇女顺利生产,其中29例患者生产并随访1年或以上,其他 12例患者生产后随访不足1年,仅有一例新生儿死亡且无明显先天性畸形 （占2.44%）,其他的新生儿均无先天性畸形。这些已生产的妊娠癫痫妇女在怀孕期间服用较低剂量的抗癫痫药物,卡马西平用量200～700mg/d,丙戊酸钠250～750 mg/d,托吡酯37.5～150 mg/d,奥卡西平450 mg/d,拉莫三嗪62.5～150 mg/d,氯硝安定2～4 mg/d。新生儿死亡的孕妇服用卡马西平300 mg/d。结论 本组妊娠癫痫妇女按照癫痫发作类型和癫痫综合征类型服用较低剂量的抗癫痫药物,并在专科医师的指导下和长期随访情况下用药,没有出现先天性畸型新生儿。这一方面可能是在专科医师指导下使用致畸性小的抗癫痫药物的结果,亦有可能是观察病例数不够多的原因,提示该项目研究应该持续进行。     

有氧运动对女性更年期综合征患者激素水平的影响

目的 了解有氧运动对女性更年期综合征患者激素水平的影响.方法 采用放射免疫法,测试了40名参加有氧运动和40名未参加运动的女性更年期综合征患者在卵泡期空腹状态下血清促卵泡激素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)和睾酮(T)的基础分泌值.结果 运动组血清E2和T的基础分泌值明显高于非运动组(P＜0.05),而血清P、FSH和LH两组均无显著性差异(P＞0.05).结论 有氧运动是一种适合女性更年期综合征患者的健身运动.