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目的:比较不同剂量促肾上腺皮质激素(ACTH)治疗婴儿痉挛(IS)的疗效及不良反应,为临床提供参考。方法:收集2012年1月至2015年12月在我院住院接受ACTH治疗的60例IS患儿的临床资料,采用随机数表法分为小剂量组和大剂量组各30例。小剂量组的治疗方案:ACTH 1 U/(kg·d)加入60 m L 5%葡萄糖溶液中持续泵入6 h,连用2周,治疗有效,再用2周;治疗无效,加量至25 U/d,再用2周,总疗程4周。大剂量组的治疗方案:ACTH起始剂量25 U/d,连用2周,治疗有效,再用2周;治疗无效,加量至40 U/d,再用2周,总疗程4周。两组患儿均在ACTH治疗结束后复查脑电图(EEG),并改为口服泼尼松,开始剂量为2 mg/kg,移行减量,总疗程为3个月。结果:大剂量组和小剂量组痉挛发作完全控制率分别为53.33%、46.67%,治疗有效率分别为23.33%、26.67%,两组比较差异均无统计学意义(P均>0.05);但小剂量组高血压、肥胖、易激惹、睡眠障碍发生率均低于大剂量组(P均<0.05)。结论:小剂量ACTH治疗IS疗效与大剂量ACTH相当,但不良反应较少。
Objective: To compare the efficacy and adverse reactions of different doses of adrenocorticotropic hormone (ACTH) in the treatment of infantile spasms (IS), so as to provide a reference for clinical practice. Methods: The clinical data of 60 children with IS who were admitted to our hospital from January 2012 to December 2015 were collected and divided into three groups: low dose group and high dose group (30 cases). Small doses of treatment: ACTH 1 U / (kg · d) added to 60 m L 5% glucose solution was pumped continuously for 6 h, once every 2 weeks, the treatment effective, and then 2 weeks; treatment ineffective, the amount of up to 25 U / d, then 2 weeks, the total course of 4 weeks. Treatment of high-dose group: ACTH initial dose of 25 U / d, once every 2 weeks, effective treatment, and then 2 weeks; treatment ineffective dosage to 40 U / d, then 2 weeks, the total course of 4 weeks. EEG was reviewed after ACTH treatment in both groups and changed to oral prednisone. The initial dose was 2 mg / kg. The total weight of the course of treatment was 3 months. Results: The complete control rates of spastic seizures were 53.33% and 46.67% in high-dose group and low-dose group, respectively. The effective rates were 23.33% and 26.67% respectively. There was no significant difference between the two groups (P> 0.05) The incidence of hypertension, obesity, irritability and sleep disorders in the low-dose group was lower than that in the high-dose group (all P <0.05). Conclusion: Small dose of ACTH treatment of IS and high dose of ACTH quite, but less adverse reactions.