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目的探讨在我国农村社区人群中,利用乡村医生负责治疗管理惊厥型癫患者的可行性。方法选择我国黑龙江省牡丹江市东宁县和穆棱县、宁夏吴忠市利通区和青铜峡市两个县、山西晋城市泽州县、河南焦作市武陟县、江苏扬州市邗江县、上海市金山区等6省8个县开展癫防治研究。由经过短期培训的乡卫生院医生负责筛查惊厥型癫患者,经神经科医师核查确诊,符合入选标准者进入治疗管理组。乡卫生院医生按规定方案使用苯巴比妥治疗、定期随访和管理患者。结果6个省示范区在2002—2004年2年半的时间内共有2455例惊厥型癫患者进入观察组接受苯巴比妥治疗。其中347例(26·2%)在开始治疗后2年内无发作,415例(31·3%)发作次数较入组前减少75%以上。无变化和加重者约占21%;在开始服药的前3个月中,有困倦嗜睡、头晕等轻度不良反应者占26·1%,中度不良反应占3·7%,重度为0·3%。6个省总样本中共有597例由于各种不同原因先后退组,占入组病例总数的24·3%。结论研究表明,经过短期培训的乡卫生院医生可以担负起治疗管理农村地区癫患者的任务。苯巴比妥治疗惊厥型癫癎发作效果良好,且少见严重不良反应。示范项目取得的经验适宜向我国广大农村地区和条件近似的发展中国家推广。
Objective To explore the feasibility of using a village doctor to manage patients with seizure-type epilepsy among rural community population in our country. Methods We selected two counties, Litong District and Qingtongxia City, Mudanjiang City, Heilongjiang Province, Dongning County and Muling County, Wuzhong City, Ningxia Province, Zezhou County, Jincheng City, Shanxi Province, Wudai County, Jiaozuo City, Henan Province, Qijiang County, Yangzhou City, Jiangsu Province, District 6 provinces and 8 counties to carry out prevention and treatment of epilepsy. After a short-term training of township hospitals doctor is responsible for screening patients with convulsive epilepsy, verified by neurologists, meet the inclusion criteria into the treatment management group. Township hospitals doctors prescribed the use of phenobarbital treatment, regular follow-up and management of patients. Results A total of 2455 patients with seizure-type epilepsy in the two provinces during the two-and-a-half-year period from 2002 to 2004 entered the observation group to receive phenobarbital. Of these, 347 (26.2%) had no episodes within 2 years after initiation of treatment and 415 (31.3%) had fewer episodes than 75% prior to enrollment. In the first 3 months of starting medication, those with drowsiness, drowsiness and other mild adverse reactions accounted for 26.1%, those with moderate adverse reactions accounted for 3.7% and those with severe 0 · 3%. A total of 597 cases of the 6 provincial total samples were retreated for various reasons, accounting for 24.3% of the total number of cases. Conclusions Research shows that township hospital doctors who have undergone short-term training can assume the task of managing patients with epilepsy in rural areas. Phenobarbital treatment of convulsive seizures good effect, and rare serious adverse reactions. The experience gained from demonstration projects is suitable for promotion in vast rural areas and in similar conditions in developing countries of our country.