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目的探讨拉莫三嗪(LTG)在儿童及青年癫癎治疗中的应用。方法对78例[男46例,女32例;年龄4个月~22岁(6.42±13.14)岁]因不同用药目的应用LTG治疗的癫癎患者治疗结果进行回顾性分析。其中LTG的维持剂量为2~8 mg.kg-1.d-1,与丙戊酸合用的维持量为1~5 mg.kg-1.d-1。结果 78例癫癎患儿单用或添加应用LTG治疗,除了3例出现药疹而停药外,其余75例坚持用药0.5 a以上。其中56例单药或添加治疗的患儿完全控制率73.21%(41/56例)、显效率10.71%(6/56例)、有效率8.93%(5/56例)、无效率7.14%(4/56例),总有效率92.86%;11例原来癫癎控制良好但考虑原抗癫癎药物对认知损害的患儿换用LTG治疗后,4例学习成绩明显上升;另有5例原来分别以丙戊酸、卡马西平、苯巴比妥治疗的患儿分别因出现体型肥胖、血常规异常和抑郁症状而换用LTG治疗后,原来药物不良反应消失;3例进入青年期女性患儿,为避免原来药物丙戊酸可能对妊娠的致畸影响而换用LTG治疗,获得继续良好控制。78例使用LTG的药物保留率24周、48周和2 a分别为94.87%(74/78例)、84.62%(66/78例)和75.64%(59/78例)。结论 LTG除可单药或添加用于各型癫癎的治疗外,尚可用于替换其他抗癫癎药物出现不良反应的癫癎患儿的治疗,可提高长期用药患儿的生活质量。
Objective To investigate the application of lamotrigine (LTG) in the treatment of epilepsy in children and adolescents. Methods Retrospective analysis was performed on the treatment outcome of 78 patients [46 males and 32 females; aged 4 months to 22 years (6.42 ± 13.14) years] who were treated with LTG for different medical purposes. The maintenance dose of LTG is 2 ~ 8 mg.kg-1.d-1, and the maintenance dose of valproic acid is 1 ~ 5 mg.kg-1.d-1. Results 78 children with epilepsy were treated with LTG alone or in addition. Except for the drug eruption occurred in 3 cases, the other 75 cases insisted on medication for more than 0.5 years. The complete control rate was 73.21% (41/56 cases) in 56 cases of single drug or added treatment, the effective rate was 10.71% (6/56 cases), the effective rate was 8.93% (5/56 cases) and the ineffective rate was 7.14% 4/56 cases), with a total effective rate of 92.86%; 4 cases of learning scores increased obviously in 11 cases of patients with good control of epilepsy but considering the original antiepileptic drugs for cognitive impairment after switching to LTG; and another 5 cases The original treatment with valproic acid, carbamazepine, phenobarbital, respectively, due to the emergence of body fat obesity, abnormalities and depressive symptoms switched to LTG treatment, the original drug adverse reactions disappeared; 3 cases into adolescent women Children, in order to avoid the original drug valproic acid may be teratogenic effects of pregnancy and switch to LTG treatment, to obtain continued good control. The drug retention rate of 78 patients with LTG was 94.87% (74/78 cases), 84.62% (66/78 cases) and 75.64% (59/78 cases) at 24 weeks, 48 weeks and 2 years respectively. Conclusion LTG can be used to treat epilepsy in children with adverse reactions of other anti-epilepsy drugs and improve the quality of life in long-term medication, besides single or added treatment for various types of epilepsy.