丙戊酸钠与地西泮治疗癫痫持续状态的系统评价

Curative effect of sodium valproate and diazepam on status epilepticus:a systematic review

目的系统评价丙戊酸钠与地西泮治疗癫痫持续状态(Status Epilepticus,SE)的有效性和安全性。方法按照Cochrane系统评价的要求,制定纳入与排除标准。计算机检索Cochrane图书馆、Medline、Embase、中国生物医学文献数据库、中国学术期刊全文数据库等,收集国内外关于丙戊酸钠与地西泮治疗SE的随机或半随机对照试验。按系统评价的方法,由三名研究者独立进行质量评价和资料提取,采用Rev Man 5.1软件进行Meta分析。结果共纳入9篇文献,包括400例SE患者。Meta分析结果显示:①丙戊酸钠组SE控制的有效率与地西泮组类似[RR=1.03,95%CI(0.91,1.16),P=0.65];②丙戊酸钠组SE复发率明显低于地西泮组[RR=0.41,95%CI(0.22,0.79),P=0.007];③丙戊酸钠组药物的不良反应发生率明显低于地西泮组[RR=0.17,95%CI(0.08,0.34),P<0.0001]。结论丙戊酸钠可有效控制SE,药物不良反应少,癫痫复发率低,是治疗SE的理想药物。

Objective To assess the curative effect and safety of sodium valproate and diazepam on status epilepticus （SE）. Methods Inclusion and exclusion criteria was established according to the criteria recommended by the Cochrane Handbook for Systematic Re- views. The database of the Coehrane Library, Medline, Emhase, CBMdisc, CNK1 and so on were searched by a computer to collect randomized controlled trials and quasi-randomized controlled trials of sodium valproate and diazepam for patients with SE. The quality of all the trails was assessed according to the criteria recommended and the datas were extracted independently from all the trails by three reviewers. Meta-analysis was performed by RevMan 5.1 software. Results Nine articles involving 400 patients with SE were gotten. The incidence of SE control in the sodium valproate group was similar to that in the diazepam group[ RR = 1.03, 95% CI（0.91, 1.16） , P = 0.65 ]. The incidence of SE recur in the sodium valproate group was significantly lower than that in the diazepam group [ RR = 0.41,95% CI（0.22, 0.79）, P = 0.07 ]. The incidence of adverse drug reaction in sodium valproate group was significantly lower than that in the diazepam group RR = 0.17,95% CI（0.08, 0.34 ）, P 〈 0. 0001 ]. Conclusions By sodium valproate treatment in the patients with SE, the incidence of SE control was similar to diazepam treatment, but the SE recur and adverse drug reaction can be significantly reduced.