拉莫三嗪对重症颅脑外伤患者急诊术后认知功能及癫痫发生影响

摘要

Objective:To study effects of lamotrigine on cognitive function in epilepsy surgery and severe traumatic brain injury.Methods:The subjects were 86 patients with severe craniocerebral trauma, randomly divided into control group and observation group, 43 cases in each group.Two groups of patients accept the standard large craniotomy surgery, before surgery,the control group were given valproate, observation group patients oral lamotrigine,compared the incidence of EPTS and LPTE and cognitive function scores between the two groups,and compared the adverse reactions.Results:The incidence of the observation group LPTE (4.65%) was significantly lower than control group (18.60%) (χ2=4.07,P=0.04).Observation group after surgery 1 months, 3 months and 6 months of the MMSE scores were significantly higher than those in control group (P<0.01), the incidence of adverse reactions in the observation group (13.97%) was significantly lower than that in control group(32.56%)(χ2=4.97, P=0.02).Conclusion: Started oral lamotrigine in the treatment of severe craniocerebral trauma patients before operation, can significantly reduce the occurrence of early and late postoperative seizures, promote the recovery of cognitive function, and treatment of high safety.%目的:研究拉莫三嗪对重症颅脑外伤患者急诊术后认知功能及癫痫发生影响.方法:选取重症颅脑外伤患者86例,采用随机数字法将其分为对照组和观察组,每组各43例.两组患者均接受标准大骨瓣开颅减压手术治疗,实施手术前,对照组患者开始口服丙戊酸钠,观察组患者开始口服拉莫三嗪,均持续服用1个月.比较两组患者术后早期癫痫(EPTS)和晚期癫痫(LPTE)发生率,采用简易精神状态检查量表(MMSE)评价手术前后的认知功能,同时比较两组的不良反应差异.结果:两组的EPTS发生率比较无统计学差异(P>0.05),观察组的LPTE发生率(4.65%)明显低于对照组(18.60%)(χ2=4.07,P=0.04).观察组手术后的1个月、3个月及6个月的MMSE评分均明显高于对照组(P<0.01),观察组的总不良反应发生率(13.97%)明显低于对照组(32.56%)(χ2=4.97,P=0.02).结论:重症颅脑外伤患者术前即开始口服拉莫三嗪治疗,能明显降低术后早期和晚期癫痫发生,促进认知功能恢复,且治疗安全性高.