丙戊酸钠和苯妥英钠联合治疗对难治性癫痫患者痫样放电及认知功能的影响

Effect of sodium valproate combined with phenytoin sodium on the epileptiform discharge and cognitive function in patients with refractory epilepsy

目的探讨丙戊酸钠和苯妥英钠联合治疗对难治性癫痫(RE)患者痫样放电及认知功能的影响。方法选择2011年2月至2015年2月新乡医学院第三附属医院收治的213例RE患者为研究对象,根据治疗方法将患者分为苯妥英钠组、丙戊酸钠组和联合治疗组,每组71例。苯妥英钠组患者给予苯妥英钠治疗,丙戊酸钠组患者给予丙戊酸钠治疗,联合治疗组患者给予丙戊酸钠和苯妥英钠联合治疗;3组患者分别于治疗前及治疗6个月后进行脑电图检测及认知功能评分,并评定治疗效果,对3组患者脑电图改善情况、认知功能评分及临床疗效进行比较。结果联合治疗组、苯妥英钠组和丙戊酸钠组患者治疗总有效率分别为80.28%(57/71)、60.56%(43/71)、59.15%(42/71),联合治疗组患者治疗总有效率显著高于苯妥英钠组和丙戊酸钠组(χ~2=8.412、9.596,P<0.05),但苯妥英钠组与丙戊酸钠组患者治疗总有效率比较差异无统计学意义(χ~2=0.003,P>0.05)。联合治疗组、苯妥英钠组和丙戊酸钠组患者脑电图总改善率分别为80.28%(57/71)、63.38%(45/71)、60.56%(43/71),联合治疗组患者脑电图总改善率显著高于苯妥英钠组和丙戊酸钠组(χ~2=7.520、8.412,P<0.05),但苯妥英钠组与丙戊酸钠组患者脑电图总改善率比较差异无统计学意义(χ~2=0.070,P>0.05)。治疗前3组患者总智商、语言智商、操作智商评分比较差异均无统计学意义(P>0.05),治疗后3组患者总智商、语言智商、操作智商评分均显著高于治疗前(P<0.05);治疗后,联合治疗组患者总智商、语言智商、操作智商评分均显著高于苯妥英钠组和丙戊酸钠组(P<0.05),但苯妥英钠组与丙戊酸钠组患者总智商、语言智商、操作智商评分比较差异均无统计学意义(P>0.05)。结论苯妥英钠和丙戊酸钠联合治疗可有效控制RE患者痫样放电,改善认知功能,提高治疗效果。

Objective To investigate the effect of sodium valproate combined with phenytoin sodium on the epileptiform discharge and cognitive function in patients with refractory epilepsy( RE). Methods A total of 213 patients with RE were selected from February 2011 to February 2015 in the Third Affiliated Hospital of Xinxiang Medical University. The patients were divided into phenytoin sodium group,sodium valproate group and combined treatment group according to the treatment methods,71 cases in each group. The patients in the phenytoin sodium group were treated with phenytoin sodium,the patients in the sodium valproate group were treated with sodium valproate,and the patients in the combined treatment group were treated with phenytoin sodium and sodium valproate. The electroencephalogram and cognitive function score of the patients in the three groups were performed before treatment and six months after treatment,and the therapeutic effect was evaluated. The improvement of electroencephalogram,cognitive function score and clinical effect were compared among the three groups. Results The total effective rate in the combined treatment group,phenytoin sodium group and sodium valproate group was 80. 28%( 57/71),60. 56%( 43/71) and 59. 15%( 42/71) respectively,the total effective rate in the combined treatment group was significantly higher than that in the phenytoin sodium group and sodium valproate group( χ~2= 8. 412,9. 596; P < 0. 05),but there was no significant difference in the total effective rate between phenytoin sodium group and sodium valproate group( χ~2=0. 003,P > 0. 05). The improvement rate of electroencephalogram in the combined treatment group,phenytoin sodium group and sodium valproate group was 80. 28%( 57/71),63. 38%( 45/71) and 60. 56%( 43/71) respectively,the improvement rate of electroencephalogram in the combined treatment group was significantly higher than that in the phenytoin sodium group and sodium valproate group( χ~2= 7. 520,8. 412; P < 0. 05),but there was no significant difference in the improvement rate of electroencephalogram between phenytoin sodium group and sodium valproate group( χ~2= 0. 070,P > 0. 05). There was no significant difference in the scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient in the three groups before treatment( P > 0. 05). The scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient after treatment were significantly higher than those before treatment in the three groups( P <0. 05). After treatment,the scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient in the combined treatment group were significantly higher than those in the phenytoin sodium group and sodium valproate group( P > 0. 05); but there was no significant difference in the scores of total intelligence quotient,language intelligence quotient and performance intelligence quotient between the phenytoin sodium group and sodium valproate group( P > 0. 05).Conclusion Phenytoin sodium combined with sodium valproate can effectively control the epileptiform discharge,improve the cognitive function and improve the therapeutic effect in RE patients.