脑瘫伴癫痫患儿合理用药研究

Rational drug use in children with cerebral palsy and epilepsy

目的分析我院脑瘫合并癫痫患儿口服抗癫痫药(AEDs)的用药情况,促进我院AEDs的合理使用。方法回顾性分析我院2016年1月至2017年12月儿科·儿童康复科一病区和二病区诊断为"脑性瘫痪、癫痫"的住院病例136例,对药物使用情况、临床疗效、癫痫发作频率和用药合理性进行分析。结果 AEDs排名前4位分别是丙戊酸钠口服溶液(VPA)、左乙拉西坦口服溶液(LEV)、奥卡西平混悬溶液(OXC)以及托吡酯胶囊(TPM);其中,11例超说明书用药(2例超年龄,9例超用法用量);男性患儿是女性患儿的1.96倍,7岁学龄前癫痫发作的人数为123例(占90.44%);单药治疗所占比例为63.97%,为主要治疗方式;二联用药以VPA+LEV为主,占总人数的16.91%,三联用药较少,仅8例,占总人数的5.88%,均诊断为难治性癫痫。结论我院脑瘫患儿合并癫痫的AEDs用药大部分合理,但仍有超说明书用药情况出现,应规范超说明书用药行为;同时还需注意AEDs之间的相互作用以及AEDs与其他药物之间的相互作用,对难治性癫痫患儿应多加注意,根据个人情况调整用药剂量,必要时监测患儿AEDs血药浓度。

Objective To analyze the use of oral antiepileptic drugs(AEDs)in children with cerebral palsy and epilepsy in our hospital,and to promote the rational use of AEDs in our hospital.Methods A retrospective analysis was made in 136 inpatients diagnosed with cerebral palsy and epilepsy from January 2016 to December 2017 in the first and second wards of pediatric and pediatric rehabilitation department of our hospital.The drug use,clinical efficacy,seizure frequency and rationality were analyzed.Results The top four AEDs were sodium valproate oral solution(VPA),levetiracetam oral solution(LEV),oxcarbazepine suspension solution(OXC)and topiramate capsule(TPM),of which 11 were over-prescribed(2 were over-age and 9 were over-dosage).Boys were 1.96 times as many as girls,and 123 cases(90.44%)of 7-year-old preschool epilepsy seizures occurred.Single drug treatment accounted for 63.97%,which was the main treatment method;VPA+LEV was the main combination use of drug,accounting for 16.91%of the total number;triple drug use was less,only 8 cases,accounting for 5.88%of the total number,all of which were diagnosed as intractable epilepsy.Conclusion The use of ADEs in children with cerebral palsy complicated by epilepsy in our hospital is mostly reasonable,but there are still cases of over-prescribed drug use,so we should standardize the over-prescribed drug use behavior.At the same time,we should pay attention to the interaction among AEDs and between AEDs and other drugs,and pay more attention to the children with intractable epilepsy,and adjust them according to their personal conditions.The dosage of AEDs and the blood concentration of AEDs should be monitored when necessary.