丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的效果分析

Efficacy of sodium valproate combined with levetiracetam in the treatment of epilepsy after stroke

目的探讨丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的临床效果。方法回顾性纳入枣庄市立第四医院2017年1月至2019年6月收治的脑卒中后癫痫患者180例。根据用药方案的不同,将其分为丙戊酸钠治疗组和丙戊酸钠联合左乙拉西坦治疗组。比较两组患者的临床疗效、治疗前后癫痫发作频次和每次持续时间、治疗前后蒙特利尔认知评估量表(MoCA)评分、改良Barthel量表(MBI)评分及不良反应发生情况。结果丙戊酸钠治疗组总有效率为79.8%(67/84),高于丙戊酸钠联合左乙拉西坦治疗组的96.9%(93/96),差异有统计学意义(χ^(2)=13.284,P<0.05)。治疗后,两组癫痫发作频次和每次持续时间低于治疗前,且丙戊酸钠联合左乙拉西坦治疗组低于丙戊酸钠治疗组(P<0.05)。治疗后,两组MoCA评分、MBI评分均较治疗前升高(P均<0.05),且丙戊酸钠联合左乙拉西坦治疗组MoCA评分、MBI评分高于丙戊酸钠治疗组(P<0.05)。丙戊酸钠治疗组不良反应发生率为10.7%(9/84),丙戊酸钠联合左乙拉西坦治疗组不良反应发生率为12.5%(12/96),两组比较差异未见统计学意义(χ^(2)=0.139,P=0.710)。结论丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫效果较好,可有效抑制脑卒中后癫痫患者的癫痫发作,有助于脑神经恢复,改善患者的认知功能和日常生活能力,且安全性高。

Objective To investigate the clinical efficacy of sodium valproate combined with levetiracetam in the treatment of epilepsy after stroke.Methods A total of 180 patients with post-stroke epilepsy treated in Zaozhuang Fourth Hospital from January 2017 to June 2019 were included retrospectively.According to the administration methods,they were divided into sodium valproate treatment group and sodium valproate combined with levetiracetam treatment group.Clinical efficacy,preoperative and postoperative frequency,duration of epileptic seizures,preoperative and postoperative Montreal Cognitive Assessment(MoCA)score,modified Barthel index(MBI)score,and adverse reactions before and after treatment were compared between the two groups.Results The total effective rate of sodium valproate treatment group was 79.8%(67/84),significantly higher than the 96.9%(93/96)of sodium valproate combined with levetiracetam treatment group(χ^(2)=13.284,P<0.05).After treatment,the frequency and duration of epileptic seizures in both group were lower than those before treatment,and these indexes in sodium valproate combined with levetiracetam treatment group were lower than those in sodium valproate treatment group(P<0.05).After treatment,the scores of MoCA and MBI in both group were improved,compared with preoperative scores(P<0.05);and the scores of MoCA and MBI of sodium valproate combined with levetiracetam treatment group were higher than those of sodium valproate treatment group(P<0.05).There was no significant difference in incidence of adverse reactions between sodium valproate treatment group(10.7%,9/84)and sodium valproate combined with levetiracetam treatment group(12.5%,12/96),χ^(2)=0.139,P=0.710.Conclusions Sodium valproate combined with levetiracetam is effective in the treatment of post-stroke epilepsy,which can effectively inhibit the onset of post-stroke epilepsy,improve recovery of cranial nerves,and promote cognitive function and daily living ability of patients,with high safety.