目的：探讨左乙拉西坦联合丙戊酸钠或地西泮治疗小儿热性惊厥（FS）反复发作的预防作用及安全性。方法：将90例FS反复发作患儿按随机数字表法分为观察组和对照组，各45例。对照组患儿给予丙戊酸钠或地西泮口服；观察组患儿在对照组治疗基础上给予左乙拉西坦片口服，初始剂量为15 mg/kg，bid，连续用药7 d后逐渐减量，第8～12天减量至10 mg/kg，bid，第13～15天减量至5 mg/kg，bid，第16天停药。两组患儿均随访1年，每2个月进行1次常规检查。记录随访期间两组患儿发热次数、惊厥复发率和癫痫转化情况及不良反应发生率；分别于治疗前和治疗6个月后检测两组患儿血清神经元特异性烯醇化酶（NSE）和S-100β蛋白（S-100β）水平；并采用《中国修订韦氏儿童智力量表》和《儿童适应行为评定量表》分别对两组患儿的智商和行为能力进行测评。结果：观察组和对照组分别有3、2例患儿失访。随访期内，观察组患儿的发热次数和惊厥复发率均显著少于或低于对照组，差异有统计学意义（P＜0.05）；两组患儿的癫痫转化率和不良发应发生率比较，差异均无统计学意义（P＞0.05）。治疗后，两组患儿的血清NSE和S-100β水平均较治疗前显著降低，且观察组患儿显著低于对照组，差异均有统计学意义（P＜0.05）。至末次随访，观察组患儿的言语智商、操作智商及总智商得分均显著高于对照组，认知因子、社会自制因子及行为能力总分均显著高于对照组，差异均有统计学意义（P＜0.05）。结论：左乙拉西坦联合丙戊酸钠或地西泮能够预防FS反复发作，减轻脑损伤，有助于改善患儿的智商和行为能力，从而提高其生活质量。%OBJECTIVE:To explore the preventive effect and safety of levetiracetam combined with sodium valproate of diaze-pam on recurrent febrile seizures(FS). METHODS:A total of 90 children with recurrent FS were randomly divided into observa-tion group and control group with 45 cases in each group. Control group was treated with sodium valproate or diazepam orally. On the basis of control group,observation group additionally received levetiracetam orally,with initial dose of 15 mg/kg,bid,for 7 d,and then decreasing gradually;decreasing to 10 mg/kg on 8th-12th day,bid;decreasing to 5 mg/kg on 13th-15th day,bid;drug withdrawal on 16th day. The children of 2 groups were followed up for 1 years,and received routine test every 2 months. The times of fever,the rate of recurrent convulsion,the conversion of epilepsia and the incidence of ADR were recorded in 2 groups during follow-up period. The serum levels of NSE and S-100β protein were determined in 2 groups before treatment and 6 months after treatment. The intelligence and behavior ability of 2 groups were scored by Chinese Modified Wechsler Intelligence Scale for Children and Children’s Adaptive Behavior Rating Scale. RESULTS:3 children of observation group and 2 of control group were failure in follow-up. During the follow-up period,fever times and the rate of recurrent convulsion in observation group were signifi-cantly lower than in control group,with statistical significance(P0.05). After treatment,serum levels of NSE and S-100β in 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical signif-icance(P<0.05). To the end of follow-up,verbal IQ,performance IQ and total IQ score of observation group were significantly higher than those of control group,and the cognition factor,social factor and behavior ability scores of observation group were sig-nificantly higher than those of control group,with statistical significance (P<0.05). CONCLUSIONS:Levetiracetam combined with sodium valproate or diazepam can prevent the occurrence of recurrent FS,relieve cerebral injury and improve the intelligence and behavior ability of the children,so as to improve the life quality of Children.
展开▼
