醒脑静注射液联合丙戊酸钠治疗脑卒中后癫痫疗效观察

Effect of Xingnaojing injection combined with sodium valproate in the treatment of post-stroke epilepsy

目的观察醒脑静注射液联合丙戊酸钠治疗脑卒中后癫痫的疗效和安全性。方法选择2017年10月至2019年10月江苏大学附属金坛医院收治的86例脑卒中后癫痫患者为研究对象,采用随机数字表法将患者分为对照组和观察组,每组43例,剔除中途终止和随访脱落者,最终纳入疗效评估者对照组42例、观察组41例。2组患者均给予丙戊酸钠缓释片500 mg,口服,每日2次,治疗4周;在此基础上,观察组患者给予醒脑静注射液20 mL,静脉滴注,每日1次,治疗4周。比较2组患者总有效率、治疗期间不良反应发生率及治疗前后累及导联数和痫样放电情况;分别于治疗前后采用双抗体夹心酶联免疫吸附法检测2组患者血清神经元特异性烯醇化酶(NSE)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平,采用酶联免疫吸附法检测血清细胞间黏附分子-1(ICAM-1)水平。结果观察组和对照组患者总有效率分别为95.12%(39/41)、73.81%(31/42),观察组患者总有效率显著高于对照组(χ2=8.765,P<0.05)。治疗前2组患者累及导联数和痫样放电次数比较差异无统计学意义(P>0.05)。2组患者治疗后累及导联数和痫样放电次数均低于治疗前(P<0.01);治疗后,观察组患者累及导联数和痫样放电次数均低于对照组(P<0.01)。治疗前2组患者血清NSE、TNF-α、IL-6、ICAM-1水平比较差异无统计学意义(P>0.05)。2组患者治疗后血清NSE、TNF-α、IL-6、ICAM-1水平均低于治疗前(P<0.01);治疗后,观察组患者血清NSE、TNF-α、IL-6、ICAM-1水平低于对照组(P<0.01)。对照组和观察组患者不良反应发生率分别为9.52%(4/42)、12.20%(5/41),2组患者不良反应发生率比较差异无统计学意义(χ2=1.037,P>0.05)。结论醒脑静注射液联合丙戊酸钠治疗能降低脑卒中后癫痫患者血清NSE、TNF-α、IL-6和ICAM-1水平,治疗效果优于单用丙戊酸钠,且不增加不良反应发生率。

Objective To observe the efficacy and safety of Xingnaojing injection combined with sodium valproatein in the treatment of post-stroke epilepsy.Methods Eighty-six post-stroke epilepsy patients in Jintan Hospital Affiliated to Jiangsu University from October 2017 to October 2019 were selected as the research objects.The patients were divided into control group(n=43)and observation group(n=43)by using the random number table.The patients who withdrawal from the study or loss of follow-up were eliminated.Finally,42 patients were assigned to the control group and 41 patients were assigned to the observation group.All patients took orally sustained-release tablets 500 mg,twice a day for 4 weeks;on this basis,the patiens in the observation group were given Xingnaojing injection 20 mL for 4 weeks.The total effective rate and adverse reactions of patients were compared between the two groups.The number of involved lead and epileptiform discharge of patients were compared between the two groups before and after treatment.The serum levels of neuron specific enolase(NSE),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)of patients were detected by double antibody sandwich enzyme-linked immunosorbent assay(ELISA),and the serum levels of intercellular adhesion molecule-1(ICAM-1)of patients were detected by ELISA.Results The total effective rate of patients in the observation group and control group was 95.12%(39/41),73.81%(31/42),respectively;the total effective rate of patients in the observation group was significantly higher than that in the control group(χ2=8.765,P<0.05).There was no significant difference in the number of involved lead and epileptiform discharge of patients between the two groups before treatment(P>0.05).The number of involved lead and epileptiform discharge of patients after treatment was significantly lower than that before treatment in the two groups(P<0.01);after treatment,the number of involved lead and epileptiform discharge of patients in the observation group were lower than those in the control group(P<0.01).There was no significant difference in serum NSE,TNF-α,IL-6 and ICAM-1 levels of patients between the two g roups before treatment(P>0.05).The serum NSE,TNF-α,IL-6 and ICAM-1 levels of patients in the two groups after treatment were significantly lower than those before treatment(P<0.01);the serum NSE,TNF-α,IL-6 and ICAM-1 levels of patients in the observation group were significantly lower than those in the control group after treatment(P<0.01).The incidence of adverse reactions in the control group and observation group was 9.52%(4/42),12.20%(5/41),respectively;there was no significant difference in the incidence of adverse reactions between the two groups(χ2=1.037,P>0.05).Conclusion Xingnaojing injection combined with sodium valproate can reduce the serum levels of NSE,TNF-α,IL-6 and ICAM-1 of patients with post-stroke epilepsy.The therapeutic effect is better than sodium valproate alone,and does not increase the occurrence of adverse reactions.