左乙拉西坦注射液治疗惊厥性癫痫持续状态的疗效及预后

Efficacy and Prognosis of Levetiracetam Injection in the Treatment of Convulsive Status Epilepsy

目的分析左乙拉西坦注射液对惊厥性癫痫持续状态(CSE)的控制效果及预后,以期在临床推广应用。方法收集2018年9月至2021年4月曲靖市第一人民医院神经内科重症监护室(NICU)CSE患者80例,按照随机分组原则选取左乙拉西坦组(实验组)40例,丙戊酸钠组(对照组)40例,比较其疗效、不良反应、脑电图变化、Synek分级及预后。结果左乙拉西坦组有效控制率为77.5%,丙戊酸钠组有效控制率为67.5%,2组无统计学差异(P=0.317)。左乙拉西坦组较丙戊酸钠组起效时间更短,2组具有统计学差异(P<0.05)。预后分析:单因素分析显示,症状未得到有效控制、控制成功的时间≥60 min、脑电图有异常放电以及Synek分级和预后不良显著相关,差异有统计学意义(P<0.05),多因素Logitstic回归分析结果显示,Synek分级与预后呈负相关(β=-3.867,OR<1),Synek分级较高是预后不良的独立危险因素及预测因素(P<0.05)。结论左乙拉西坦注射液对CSE的控制更迅速、控制效果更显著,可应用于临床,脑电图分析(脑电图异常放电、Synek分级)可为判断CSE预后提供可靠依据。

Objective To analyze the control effect and prognosis of Levetiracetam injection on convulsive epileptic status(CSE),in order to promote its clinical application.Methods A total of 80 CSE patients were enrolled in the Department of Neurology intensive Care Unit(NICU)of Qujing No.1 Hospital from September 2018 to April 2021.40 patients in the Levetiracetam group(experimental group)and 40 patients in the Valproate group(control group)were randomly assigned to compare the efficacy,adverse reactions,EEG changes,Synek grading and prognosis.Results The effective control rate was 77.5%in the Levetiracetam group and 67.5%in the Valproate group,with no statistical difference between the two groups(P=0.317).The onset time of Levetiracetam group was shorter than that of Valproate group,and the difference between the two groups was statistically significant(P<0.05).Prognostic analysis:Univariate analysis showed that symptoms were not effectively controlled,successful control time≥60 min,abnormal discharge in EEG,Synek grading and poor prognosis were significantly correlated(P<0.05).Multivariate Logitstic regression analysis showed that,Synek grade was negatively correlated with prognosis(β=-3.867,OR<1),and higher Synek grade was an independent risk factor and predictor of poor prognosis(P<0.05).Conclusion Levetiracetam injection can control CSE more quickly and effectively,which can be used in clinic.EEG analysis(EEG abnormal discharge and Synek grading)can provide a reliable basis for judging the prognosis of CSE.