新生儿惊厥患者苯巴比妥规范治疗及管理效果分析

Analysis on the effects of standard treatment and management of phenobarbital in patients with neonatal convulsions

目的探讨新生儿惊厥患者苯巴比妥规范治疗及管理效果分析。方法回顾性分析2017年3月~2019年3月笔者所在医院收治的50例新生儿惊厥患者临床资料,所有患者均给予常规治疗及苯巴比妥抗惊厥治疗。观察患者临床特点及转归。结果50例患者病因分别为HIE[58.0%(29/50)]、ICH[18.0%(9/50)]、低血糖[8.0%(4/50)]、低钙血症[6.0%(3/50)]、脑膜炎[10.0%(5/50)],以HIE为主(χ^2=4.556,P=0.033)。惊厥发作于出生后24h内31例。惊厥发作特点依次为微小型发作33例,阵挛发作6例,强直-阵挛型4例,肌阵挛型4例,强直发作3例。50例患者药物起效时间和惊厥停止时间分别为(15.75±5.47)min、(21.38±3.96)min。经治疗显效41例,有效5例,2例无效,2例重症HIE合并多器官功能衰竭死亡。其中微小型发作患者治疗有效率明显高于非微小型发作患者,差异有统计学意义(χ^2=4.173,P=0.039)。结论新生儿惊厥的主要病因为HIE,主要发作特点为微小型发作,微小型发作患者治疗有效率明显高于其他类型发作患者。苯巴比妥可作为抗惊厥治疗首选药物,可获满意临床疗效。

Objective To investigate the analysis on the effects of standard treatment and management of phenobarbital in patients with neonatal convulsions.Methods The clinical data of 50 patients with neonatal convulsions admitted and treated inthe authors’hospital from March 2017 to March 2019 were retrospectively analyzed.All patients were given conventional therapy and phenobarbital anticonvulsant therapy.The clinical characteristics and outcome of patients were observed.Results The etiology of 50 patients was HIE[58.0%(29/50)],ICH[18.0%(9/50)],hypoglycemia[8.0%(4/50)],hypocalcemia[6.0%(3/50)],and meningitis[10.0%(5/50)],respectively,with HIE being the major cause(χ^2=4.556,P=0.033).Convulsions occurred within 24h after birth in 31 cases.The convulsive seizure was characterized by microscale seizure in 33 cases,clonic seizure in 6 cases,tonic-clonic seizure in 4 cases,myoclonic seizure in 4 cases,and tonic seizure in 3 cases.The drug onset time and convulsion stopping time in 50 patients were(15.75±5.47)min and(21.38±3.96)min,respectively.After treatment,41 cases showed obvious effect,5 cases were effective,2 cases were ineffective,and 2 cases died of severe HIE complicated with multiple organ failure.Among which,the response rate of the patients with microscale seizure was significantly higher than the patients with non-microscale seizure,with statistically significant difference(χ^2=4.173,P=0.039).Conclusion The major etiology of neonatal convulsions is HIE,the seizure is mainly characterized by microscale seizure,and the response rate of the patients with microscale seizure is significantly higher than the patients with other types of seizure.Phenobarbital can be used as the first choice for anticonvulsant therapy with satisfactory clinical efficacy.