CAJ | 학술논문

目的探讨颅脑损伤后应用抗癫痫药(AEDs)预防创伤后癫痫的疗效.方法广泛检索PubMed、Ovid、Springer、维普、CNKI等数据库,对相关文献进行严格评价,最终纳入的21篇文献通过Meta分析,研究预防应用AEDs对创伤后早期、晚期癫痫是否有作用,研究颅脑损伤类型(外伤、颅脑手术)对预防用药效果的影响及预防用药后患者死亡率等情况.结果在对预防用药是否有意义评价中,差异有统计学意义(OR=0.66,Z=4.310,P=0.000),故支持给药;在对早期癫痫预防用药效果评价中,差异有统计学意义(OR=0.48,Z=3.980,P=0.000),苯妥英钠组(OR=0.53)比卡马西平组(OR=0.40)对早期癫痫的预防效果更优;在对晚期癫痫预防用药效果评价中,差异没有统计学意义(OR=1.05,Z=0.310,P=0.760);在对不同类型颅脑损伤预防用药效果评价中,都具有应用意义(脑外伤OR=0.48,颅脑手术OR=0.69);在预防用药对死亡率影响比较分析中,对患者的死亡率都没有影响(OR=0.82,Z=0.920,P=0.360).结论在已研究的药物范围内,颅脑损伤后预防性应用AEDs可使癫痫发病率明显降低;苯妥英钠对早期癫痫的预防效果较好;各类AEDs对晚期癫痫的预防效果差异无统计学意义;在外伤后癫痫和颅脑手术后癫痫患者中预防应用AEDs效果无明显差异;预防应用AEDs后对患者死亡率没有明显影响.
목적 탐토로뇌손상후응용항전간약(AEDs)예방창상후전간적료효.방법 엄범검색PubMed、Ovid、Springer、유보、CNKI등수거고,대상관문헌진행엄격평개,최종납입적21편문헌통과Meta분석,연구예방응용AEDs대창상후조기、만기전간시부유작용,연구로뇌손상류형(외상、로뇌수술)대예방용약효과적영향급예방용약후환자사망솔등정황.결과 재대예방용약시부유의의평개중,차이유통계학의의(OR=0.66,Z=4.310,P=0.000),고지지급약;재대조기전간예방용약효과평개중,차이유통계학의의(OR=0.48,Z=3.980,P=0.000),분타영납조(OR=0.53)비잡마서평조(OR=0.40)대조기전간적예방효과경우;재대만기전간예방용약효과평개중,차이몰유통계학의의(OR=1.05,Z=0.310,P=0.760);재대불동류형로뇌손상예방용약효과평개중,도구유응용의의(뇌외상OR=0.48,로뇌수술OR=0.69);재예방용약대사망솔영향비교분석중,대환자적사망솔도몰유영향(OR=0.82,Z=0.920,P=0.360).결론 재이연구적약물범위내,로뇌손상후예방성응용AEDs가사전간발병솔명현강저;분타영납대조기전간적예방효과교호;각류AEDs대만기전간적예방효과차이무통계학의의;재외상후전간화로뇌수술후전간환자중예방응용AEDs효과무명현차이;예방응용AEDs후대환자사망솔몰유명현영향.
Objective To determine the efficacy ofantiepileptic drugs (AEDs) on prevention of epilepsy after craniocerebral injury. Methods Related articles searched from the databases such as PubMed, Ovid, Springer, VP and CNKI were collected and strictly evaluated; 21 articles were finally selected. Whether pretreatment with AEDs played its role in epilepsy appeared in the early/late stages was discussed with Meta-analysis; the influences of different craniocerebral injury types (resulting from trauma or surgery) on the efficacy of anti-epilepsy prophylaxis, and the mortality rate of the patients performed pretreatment were analyzed with Meta-analysis. Results Pretreatment withAEDs could significantly improve the results (OR=0.66, Z=4.31, P=0.000); pretreatment with AEDs obviously decreased the rate of epilepsy appeared in the early stage (OR=0.48, Z=3.980, P=0.000), but did not statistically decrease the rate of epilepsy appeared in the late stage (OR=1.05, Z=0.310, P=0.760);pretreatment with diphenylhydantoin (OR=0.53) was more effective on epilepsy appeared in the early stage than pretreatment with carbamazepine (OR=0.40). Pretreatment with AEDs was all-effective considering different craniocerebral injury types resulting from trauma (OR=0.48) and surgery (OR=0.69). No significant differences were noted on the mortality rate of patients performed pretreatment and without pretreatment (OR=0.82, Z=0.920, P=0.360). Conclusion The inception rate of epilepsy can be decreased remarkably after anti-epilepsy prophylaxis with AEDs in patients after craniocerebral injury,and diphenylhydantoin has a better effect for epilepsy appeared in the early stage. No reasonable differences between various kinds of AEDs on epilepsy appeared in the late stage are noted. Pretreatment with AEDs enjoys a good result in both post-traumatic brain injury and craniotomy. Pretreatment can not affect the mortality rate of the patients.