医师-药师联合门诊会诊癫痫患者467例

Treatment of patients with epilepsy in neurologist and pharmacist's joint outpatient department: 467 cases report

目的对医师-药师联合门诊就诊癫痫患者的发作类型、病因及用药情况进行现况调查,为抗癫痫药物合理化应用提供参考。方法收集天坛医院医师-药师联合门诊就诊的癫痫患者467例,对其一般人口学资料、病程、发作类型、病因、应用抗癫痫药物状况等进行统计分析。结果 467例患者,男性263例(56.3%),女性204例(43.7%);年龄14～90岁,平均年龄(35.21±15.32)岁;病程2w～40年,中位数为6年(四分位间距2～15);发作类型:全面性强直-阵挛发作274例(58.7%),局灶性发作65例(13.9%),局灶+全面发作116例(24.8%),未知发作类型12例(2.6%)。癫痫病因依次为脑血管病61例、颅脑创伤46例、海马病变46例、颅内感染41例,脑发育不良25例、脑肿瘤19例、围产期脑损伤17例等;有明确家族史者为14例,青少年肌阵挛(JME)13例,原因不明172例。癫痫单药治疗者240例(51.4%);2药联合治疗114例(24.4%);3种以上29例(6.2%),未服药者81例(17.3%),不规律服药者70例(14.99%)。规律服抗癫痫药物保持1年以上无发作者104例,占22.3%。出现各种不良反应频次97次,其中肝酶升高、血白细胞减少,体质量增加及震颤排列靠前。结论针对癫痫患者建立的联合门诊诊疗模式很有必要,可以为患者提供更优化的药物治疗方案。本研究为将来癫痫患者的门诊就诊模式的发展提供参考。

Objective To investigate and analyze the type of seizure, etiology and medical treatment of patients with epilepsy from a neurologist and pharmacist's joint outpatient department. Method The etiology, duration and type of epilepsy and anti-epilepsy drug treatment of 467 patients with epilepsy from August 2017 to August 2018 in neurologist and pharmacist's joint outpatient department of Tiantan hospital were reviewed retrospectively. Results A total of 467 cases with epilepsy aged from 14-90 years old(35.21±15.32) were selected. 263 cases( 56.3%) were male and 204 cases( 43.7%) were female. The duration of epilepsy ranged from 2 weeks to 40 years. Their median duration was 6 years( interquartile range 2-15). 274 patients( 58.7%) had the diagnosis of general seizure. 65 patients( 13.9%) had the diagnosis of focal seizure. 116 patients( 24.8%) had the diagnosis of generalized tonic-clonic seizure and focal seizure. 12 patients( 2.6%) had the diagnosis of seizure of unknown type. The etiology included cerebral vascular disease( 61cases), head trauma( 46cases), intracranial infection( 41cases), tumor( 19cases), hippocampal sclerosis( 46cases), perinatal brain injury( 17cases), and focal cortical dysplasia( 25cases). 14 patients had positive family history. 13 patients had the diagnosis of juvenile myoclonic epilepsy. 172 patients( 56.3%) had the etiology of unknown. 240 patients( 51.4%) were treated by using one drug. 114 patients( 24.4%) were treated by using two drugs. 29 patients( 6.2%) were treated by using more than two drugs. 81 patients( 17.3%) had no treatment. 70( 14.99%) patients take medicine irregularly. 104 patients take medicine regularly and were seizure free for at least 1 year. Elevation of liver enzymes, leukocyte reduction,excessive weight gain and tremor were amongst the more commonly reported total 97 adverse events during the entire trial. Conclusion This model of joint care for the epilepsy patient appears to be necessary and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for epilepsy services.