丙戊酸钠治疗难治性癫(癎)持续状态疗效观察

目的 探讨丙戊酸钠治疗难治性癫(癎)持续状态的疗效.方法 我院2008-03-2011-03收治难治性癫(癎)持续状态患者29例,应用丙戊酸钠注射液治疗.结果 26例于1 h 内完全控制,控制率89.65%,本组起效时间5～15 min,平均(6±7)min,发作控制时间25～52 min,平均(38.56±10.85) min.结论 丙戊酸钠注射液治疗难治性癫(癎)持续状态具有起效快、应用安全,临床疗效确切等优点,适于临床应用.     

地西泮与丙戊酸钠注射液治疗癫癎持续状态的疗效观察

癫癎持续状态(status epilepticus,SE)又称癫癎状态,是指癫癎连续发作之间意识尚未完全恢复又频繁再发,或癫发作持续30min以上未自行停止[1]。SE是急诊科和神经内科常见的急症,年发病率高达(41～61)/10万[2]。     

单纯地西泮与地西泮联合丙戊酸治疗癫(癎)持续状态的疗效比较

目的 比较单纯地西泮和地西泮联合丙戊酸钠治疗癫(癎)持续状态(SE)的疗效.方法 选择成人SE患者35例,分成地西泮组(给予地西泮静脉治疗)和地西泮联合丙戊酸钠组(地西泮联合丙戊酸钠静脉治疗)两组,观察两组的疗效.结果 两组治疗的有效率差异无统计学意义,地西泮联合丙戊酸钠组72 h内复发率低于地西泮组(P＜0.05).结论 地西泮联合丙戊酸钠治疗可降低SE患者的复发.     

丙戊酸钠治疗难治性癫癇持续状态疗效观察

目的探讨丙戊酸钠治疗难治性癫癇持续状态的疗效。方法我院2008-03-2011-03收治难治性癫癇持续状态患者29例,应用丙戊酸钠注射液治疗。结果 26例于1h内完全控制,控制率89.65%,本组起效时间5～15min,平均（6±7）min,发作控制时间25～52min,平均（38.56±10.85）min。结论丙戊酸钠注射液治疗难治性癫癇持续状态具有起效快、应用安全,临床疗效确切等优点,适于临床应用。     

丙戊酸治疗成人癫(癎)致血浆肉毒碱下降

目的观察丙戊酸(valproic acid,VPA)治疗成人癫患者后患者血浆游离肉毒碱改变规律,并探讨导致其改变的相关因素。方法VPA治疗组为41例成人癫患者,其中接受VPA单药治疗者33例,联合其他抗癫药物治疗者8例,30例非VPA治疗的成人癫患者作为癫对照组,包括其他抗癫药物治疗的患者14例,和未进行药物治疗的患者16例。33名同龄健康者作为正常对照,用酶循环法测定血浆游离肉毒碱浓度,3组间进行比较。结果VPA治疗组血浆游离肉毒碱浓度(31.43±11.75μmol/L)明显低于正常对照组(43.25±12.57μmol/L)和非VPA治疗的癫对照组(40.71±12.83μmol/L,P均<0.05)。血浆游离肉毒碱浓度与VPA剂量、VPA疗程、其他抗癫药物、年龄、性别、血ALT、AST无相关性。结论VPA治疗成人癫可能导致血浆游离肉毒碱水平下降,其下降程度和VPA无剂量和疗程依赖性,也不受患者的生理状态以及其他抗癫药物的影响。     

小儿癫(癎)持续状态的治疗体会

癫(癎)持续状态(SE)又称癫(癎)状态,是指癫(癎)持续频繁的发作,持续 30 min以上或连续多次发作,发作期间意识或神经功能不能恢复至正常水平[1].癫(癎)持续状态下脑缺氧、代谢中间产物蓄积,造成脑水肿、神经元死亡,是小儿神经内科急危重症.我科于2008-08～2010-02,收治32例SE患者,现报道如下.     

癫(癎)持续状态的护理体会

我科自2007-01～2009-01共救治癫NFDCC持续状态患者23例,效果理想,现将我们在这方面的护理体会报告如下.1 临床资料1.1 一般资料本组23例癫NFDCC持续状态患者,男16例,女7例,年龄8～63岁.诱因为停服、漏服或更换抗癫NFDCC药物、发热、劳累.1.2 治疗 (1)首选地西泮针10～20 mg静脉注射,＜2 mg/min,如有效,再将60～100 mg地西泮溶于5%葡萄糖生理盐水中,于12 h内缓慢静滴.(2)10%水合氯醛20～30 ml加等量植物油保留灌肠, 1次/8～12 h.     

非惊厥性癫(癎)持续状态

非惊厥性癫(癎)持续状态(NCSE)系临床常见但易忽视的癫(癎)持续状态(SE)发作类型,据估计,占所有癫(癎)持续状态的20%～50%.2004年,英国癫(癎)研究基金会(ERF)将非惊厥性癫(癎)持续状态定义为:由于持续性癫(癎)样脑电活动导致的一系列非惊厥临床征象[1].     

广西农村部分地区癫(癎)及丙戊酸钠疗效的初步调查

目的 了解广西农村部分地区癫(癎)的发病情况、治疗缺口以及丙戊酸钠的疗效.方法 利用统一的调查表对广西田东、田阳、平果、天等县已确定或怀疑癫(癎)的患者进行调查,再经神经科医生复查后确诊,并对适合使用丙戊酸钠的病例进行疗效观察.结果 共诊断癫(癎)患者303例,未经治疗46.2%,西药治疗45.5%,仅中药、偏方治疗6.3%,治疗不详2.0%,其中活动性癫(癎)人数295例,治疗缺口达81.0%.295例患者进入丙戊酸钠治疗的随访研究,显效率为58.6%,总有效率为75.2%.结论 广西农村地区癫(癎)的治疗缺口较全国其他农村地区高,经丙戊酸钠治疗后,约75%患者发作可得到有效控制,但是不正规治疗可影响患者的预后,故应重视癫(癎)患者的正规治疗.     

癫(癎)持续状态研究热点与新问题

癫(癎)持续状态(SE)是神经科最为常见的急危重症.持续性癫(癎)发作不仅可以引起细胞代谢紊乱、葡萄糖和氧耗竭、离子跨膜转运障碍,甚至不能维持细胞正常生理功能,导致神经元死亡,而且还可以合并感染、电解质和酸碱平衡紊乱、呼吸和循环衰竭、肝肾功能障碍等,从而加速机体死亡.     

丙戊酸钠与地西泮治疗癫痫持续状态的系统评价

目的 系统评价丙戊酸钠与地西泮治疗癫痫持续状态(Status Epilepticus,SE)的有效性和安全性.方法 按照Cochrane系统评价的要求,制定纳入与排除标准.计算机检索Cochrane图书馆、Medline、Embase、中国生物医学文献数据库、中国学术期刊全文数据库等,收集国内外关于丙戊酸钠与地西泮治疗SE的随机或半随机对照试验.按系统评价的方法,由三名研究者独立进行质量评价和资料提取,采用Rev Man 5.1软件进行Meta分析.结果 共纳入9篇文献,包括400例SE患者.Meta分析结果显示:①丙戊酸钠组SE控制的有效率与地西泮组类似[RR=1.03,95％CI(0.91,1.16),P=0.65];②丙戊酸钠组SE复发率明显低于地西泮组[RR=0.41,95％ CI(0.22,0.79),P=0.007];③丙戊酸钠组药物的不良反应发生率明显低于地西泮组[RR =0.17,95％ CI(0.08,0.34),P＜0.0001].结论 丙戊酸钠可有效控制SE,药物不良反应少,癫痫复发率低,是治疗SE的理想药物.     

锂-匹罗卡品致大鼠癫癎持续状态后脑内神经元的凋亡

探讨癫持续状态 (StatusEpilepticus,SE)时细胞凋亡的发生及其与海马硬化的关系。采用锂 匹罗卡品诱发大鼠SE模型 ,在SE的不同时点采大鼠脑标本 ,利用TUNEL染色方法检测大鼠海马皮质神经元的凋亡出现情况。结果发现 ,正常对照组大鼠大脑皮质可见散在的TUNEL阳性细胞 ,海马区未见TUNEL阳性细胞。SE1h ,皮质TUNEL阳性细胞数即开始增加 ,SE后 8h ,海马区开始出现TUNEL阳性细胞 ,SE后 1d ,大脑皮质TUNEL阳性细胞数开始明显增加 ,海马区也可见到较多TUNEL阳性细胞。SE后 5d ,皮质及海马的TUNEL阳性细胞数达到高峰。 7d时皮质及海马TUNEL阳性数均明显下降。结果提示 ,SE可引起神经元凋亡 ,5d时达到高峰 ,7d时已明显下降。神经元凋亡与SE引起的迟发性神经元死亡有关 ,并参与了海马硬化的形成。     

巢蛋白阳性星形胶质细胞与癫痫持续状态后海马区胶质瘢痕形成的相关性研究

目的 了解癩痫持续状态(SE)后7d海马各区巢蛋白(nestin)阳性星形胶质细胞表达及数目的变化,探讨其与SE导致海马区胶质瘢痕形成的关系.方法 SD大鼠随机分为SE组和对照组,应用匹罗卡品建立SE大鼠模型;在SE后7d处死大鼠行盲法免疫荧光组化实验,观察大鼠海马各区nestin与胶质纤维酸性蛋白单克隆抗体(GFAP...     

A comparison of four antiepileptic drugs in status epilepticus: experience from India

Purpose: We report the efficacy and safety of lorazepam (LOR), phenytoin (PHT), valproate (VPA) and levetiracetam (LEV) as first and second choice antiepileptic drug (AED) in status epilepticus (SE) and their combinations in preventing refractory SE. Materials and methods: The results of our two earlier trials on SE were compared; one evaluated VPA versus PHT (group I) and the other LOR versus LEV (group II). In group I, additional patients were recruited in addition to published data. The primary outcome was cessation of SE after first and second AEDs and secondary outcome was mortality and side effects. The efficacy of these four drugs as first and second choice was compared. The frequency of refractory seizure in groups I and II and their contributing factors were analyzed. Results: One hundred and seventeen patients were in group I and 79 in group II. The baseline characteristics of the patients were similar in LOR, LEV, VPA and PHT groups. As a first choice, LOR controlled SE in 75.1%, LEV in 76.3%, VPA in 55.4% and PHT in 44.2% patients. As a second choice, LEV was effective in 88.9%, LOR in 70%, VPA in 74.1% and PHT in 25% patients. Refractory SE was more frequent in group I than group II (29.9% versus 10.5%), however, complications and mortality were higher in group II. Conclusion: LOR and LEV combination was superior in reducing refractory SE but at the cost of higher complications and death.     

Why we prefer levetiracetam over phenytoin for treatment of status epilepticus

Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine‐resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time‐consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine‐resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment.     

醒脑静注射液治疗脑卒中伴意识障碍的疗效及安全性

目的探讨醒脑静注射液治疗脑卒中伴意识障碍的临床疗效及安全性,总结经验以提高临床治疗水平及保证用药安全性。方法将2013-10—2015-04我科收治120例脑卒中伴意识障碍患者随机分成对照组和观察组,各60例,其中对照组给予神经内科常规综合治疗,观察组在对照组基础上给予醒脑静注射液治疗,记录相关临床资料并作回顾性分析。结果治疗7d后治疗组的GCS评分大于对照组,但差异无统计学意义(P0.05);治疗14d后治疗组的GCS评分大于对照组,且差异具有统计学意义(P0.05);观察组的总有效率大于对照组,且差异具有统计学意义(P0.05);2组间不良反应发生率差异无统计学意义(P0.05)。结论醒脑静注射液治疗脑卒中伴意识障碍能够有效提高患者的GCS评分,显著改善意识障碍状况,且用药安全。     

Valproate is an effective, well-tolerated drug for treatment of status epilepticus/serial attacks in adults

Objective – Status epilepticus (SE) and serial attacks (SA) represent neurological emergencies, and mortality rate for SE/SA is high, ranging from 3% to 25%, depending on cause and co-morbidity. As SE/SA become more refractory to treatment over time, rapid, appropriate treatment is extremely important. Here, we report a prospective registration of the effect of intravenous (IV) valproate (VPA) on SE/SA in a group of Norwegian patients.
Patients and methods – Forty-one adult patients (18 males, 23 females) were included in the study. All had previously been unsuccessfully treated with diazepam. For 19, the main SE/SA seizure type was generalized tonic-clonic, while 16 had complex-partial seizures. Six had seizures that were difficult to classify. The treatment protocol recommended 25 mg/kg of VPA loading dose over 30 min, followed by continuous infusion of 100 mg/h for at least 24 h, then per oral administration. If seizures persisted after the loading dose, general anaesthesia (barbiturates/propofol/midazolam) was administered.
Results – No serious side effects were reported. In 76% of the cases (31 of 41), SE/SA stopped and anaesthesia was not required. Of the patients treated within 3 h, only 5% needed anaesthesia, whereas of those treated after 3–24 h, 38% needed anaesthesia. Of those who waited for more than 24 h before treatment, 60% required anaesthesia. Furthermore, 60% of the patients who needed anaesthesia were given loading doses below 2100 mg.
Conclusions – VPA seems to be a safe, effective treatment of SE/SA, but efficacy is dependent on time lapse between symptoms and VPA treatment, and administration of a sufficiently high loading dose.     

醒脑静注射液治疗急性脑出血的疗效观察

目的 观察醒脑静注射液治疗急性脑出血的临床疗效.方法 选取我院2012-01-2014-01收治的急性脑出血患者65例,随机分为2组,均给予脱水降颅压、神经营养及康复等治疗措施,对照组32例,在常规治疗的基础上加用胞二磷胆碱钠注射液入5％葡萄糖注射液250mL中静滴,1次/d;试验组33例在常规治疗的基础上加用20 mL醒脑静注射液加入250mL 0.9％氯化钠注射液中静滴,1次/d.2组均治疗14 d为一个疗程.观察2组患者治疗前后美国国立卫生研究院卒中量表(NIHSS)评分及日常生活活动能力评分(ADL),检测治疗前后血清超敏C反应蛋白(hs-CRP)的水平,对比2组临床疗效.结果 治疗14 d后,试验组患者血清hs-CRP水平较对照组下降更为显著,差异有统计学意义(P＜0.05);2组治疗后NIHSS评分及ADL评分均有所改善,但试验组改善更为明显(P＜0.05);试验组总有效率明显高于对照组,2组比较差异有统计学意义(P＜0.05).结论 醒脑静注射液治疗急性脑出血患者效果明显,可有效改善患者神经功能,提高日常生活活动能力,降低血清hs-CRP水平,且安全性较高,值得临床推广.