中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
19期
1483-1487
,共5页
朱登纳%谢蒙蒙%王军%王俊辉%王明梅%张广宇%马德有%熊华春%孙莉
硃登納%謝矇矇%王軍%王俊輝%王明梅%張廣宇%馬德有%熊華春%孫莉
주등납%사몽몽%왕군%왕준휘%왕명매%장엄우%마덕유%웅화춘%손리
难治性癫(癇)%生酮饮食%保留率%认知功能
難治性癲(癇)%生酮飲食%保留率%認知功能
난치성전(간)%생동음식%보류솔%인지공능
Refractory epilepsy%Ketogenic diet%Retention rates%Cognitive function
目的 观察生酮饮食(KD)添加治疗儿童难治性癫(癇)的临床疗效、保留率、不良反应及其对认知功能的影响,并比较住院治疗组与门诊治疗组不同实施方案的临床疗效及保留率.方法 选择2012年5月至2013年10月在郑州大学第三附属医院河南省小儿脑瘫康复治疗中心接受添加治疗的36例难治性癫(癇)患儿,包括住院治疗组及门诊治疗组,住院治疗组KD方案采用经典模式,即启动时禁食,脂肪和蛋白质、碳水化合物比例为4∶1;门诊治疗组KD方案无需禁食,脂肪和蛋白质、碳水化合物比例由1∶1逐渐升高至4∶1,疗效的评估以KD添加治疗前癫(癇)发作频率为基线,通过家长记录癫(癇)日记,了解癫(癇)发作的频率、类型、每次发作持续时间、发作程度变化,并于添加KD治疗前及KD治疗3、6、12个月行Gesell发育量表评定.结果 住院治疗组KD治疗3、6、12个月总有效率分别为60.0％、45.0％、40.0％,保留率分别为80.0％、55.0％、40.0％,完全控制率30.0％;门诊治疗组3、6、12个月总有效率分别为37.5％、25.0％、18.8％,保留率分别为62.5％、37.5％、18.8％,完全控制率12.5％;住院治疗组与门诊治疗组临床疗效比较差异有统计学意义(P＜0.05),保留率比较差异无统计学意义(P＞0.05);住院治疗组短期不良反应主要表现为胃肠道反应,长期不良反应为肾结石1例,门诊治疗组不良反应多轻微;36例难治性癫(癇)患儿认知功能改善共9例,住院治疗组6例,门诊治疗组3例,五大能区发育商多组间比较大运动(F=3.287,P=0.025)及适应性能区(F=8.335,P=0.000)差异有统计学意义.结论 KD添加治疗儿童难治性癫(癇)住院治疗与门诊治疗均安全有效;住院治疗组的疗效较门诊治疗组好,2组保留率相当;提高患者依从性仍是KD治疗成败的重要因素;KD治疗对难治性癫(癇)患儿的认知功能有所改善,主要表现在大运动及适应性能区.
目的 觀察生酮飲食(KD)添加治療兒童難治性癲(癇)的臨床療效、保留率、不良反應及其對認知功能的影響,併比較住院治療組與門診治療組不同實施方案的臨床療效及保留率.方法 選擇2012年5月至2013年10月在鄭州大學第三附屬醫院河南省小兒腦癱康複治療中心接受添加治療的36例難治性癲(癇)患兒,包括住院治療組及門診治療組,住院治療組KD方案採用經典模式,即啟動時禁食,脂肪和蛋白質、碳水化閤物比例為4∶1;門診治療組KD方案無需禁食,脂肪和蛋白質、碳水化閤物比例由1∶1逐漸升高至4∶1,療效的評估以KD添加治療前癲(癇)髮作頻率為基線,通過傢長記錄癲(癇)日記,瞭解癲(癇)髮作的頻率、類型、每次髮作持續時間、髮作程度變化,併于添加KD治療前及KD治療3、6、12箇月行Gesell髮育量錶評定.結果 住院治療組KD治療3、6、12箇月總有效率分彆為60.0％、45.0％、40.0％,保留率分彆為80.0％、55.0％、40.0％,完全控製率30.0％;門診治療組3、6、12箇月總有效率分彆為37.5％、25.0％、18.8％,保留率分彆為62.5％、37.5％、18.8％,完全控製率12.5％;住院治療組與門診治療組臨床療效比較差異有統計學意義(P＜0.05),保留率比較差異無統計學意義(P＞0.05);住院治療組短期不良反應主要錶現為胃腸道反應,長期不良反應為腎結石1例,門診治療組不良反應多輕微;36例難治性癲(癇)患兒認知功能改善共9例,住院治療組6例,門診治療組3例,五大能區髮育商多組間比較大運動(F=3.287,P=0.025)及適應性能區(F=8.335,P=0.000)差異有統計學意義.結論 KD添加治療兒童難治性癲(癇)住院治療與門診治療均安全有效;住院治療組的療效較門診治療組好,2組保留率相噹;提高患者依從性仍是KD治療成敗的重要因素;KD治療對難治性癲(癇)患兒的認知功能有所改善,主要錶現在大運動及適應性能區.
목적 관찰생동음식(KD)첨가치료인동난치성전(간)적림상료효、보류솔、불량반응급기대인지공능적영향,병비교주원치료조여문진치료조불동실시방안적림상료효급보류솔.방법 선택2012년5월지2013년10월재정주대학제삼부속의원하남성소인뇌탄강복치료중심접수첨가치료적36례난치성전(간)환인,포괄주원치료조급문진치료조,주원치료조KD방안채용경전모식,즉계동시금식,지방화단백질、탄수화합물비례위4∶1;문진치료조KD방안무수금식,지방화단백질、탄수화합물비례유1∶1축점승고지4∶1,료효적평고이KD첨가치료전전(간)발작빈솔위기선,통과가장기록전(간)일기,료해전(간)발작적빈솔、류형、매차발작지속시간、발작정도변화,병우첨가KD치료전급KD치료3、6、12개월행Gesell발육량표평정.결과 주원치료조KD치료3、6、12개월총유효솔분별위60.0％、45.0％、40.0％,보류솔분별위80.0％、55.0％、40.0％,완전공제솔30.0％;문진치료조3、6、12개월총유효솔분별위37.5％、25.0％、18.8％,보류솔분별위62.5％、37.5％、18.8％,완전공제솔12.5％;주원치료조여문진치료조림상료효비교차이유통계학의의(P＜0.05),보류솔비교차이무통계학의의(P＞0.05);주원치료조단기불량반응주요표현위위장도반응,장기불량반응위신결석1례,문진치료조불량반응다경미;36례난치성전(간)환인인지공능개선공9례,주원치료조6례,문진치료조3례,오대능구발육상다조간비교대운동(F=3.287,P=0.025)급괄응성능구(F=8.335,P=0.000)차이유통계학의의.결론 KD첨가치료인동난치성전(간)주원치료여문진치료균안전유효;주원치료조적료효교문진치료조호,2조보류솔상당;제고환자의종성잉시KD치료성패적중요인소;KD치료대난치성전(간)환인적인지공능유소개선,주요표현재대운동급괄응성능구.
Objective To observe the clinical efficacy,retention rates,adverse reactions of the ketogenic diet (KD) and their effects on cognitive function in children with refractory epilepsy,and to compare the clinical efficacy and retention rates of in-patient group and out-patient group.Methods This study enrolled 36 patients with refractory epilepsy who received KD therapy in Rehabilitation Center for Children with Cerebral Palsy in Henan Province of the Third Affiliated Hospital of Zhengzhou University from May 2012 to Oct.2013.They were divided into in-patient group and out-patient group.The in-patient group received classic KD therapy which started with fasting,the ratio of lipid to non-lipid was 4 ∶ 1 ;while the out-patient group was not asked for fasting,and lipid to non-lipid ratio gradually increased to 4 ∶ 1.Seizure frequency before treatment was set as the baseline,the clinical efficiency was evaluated,changes in seizure frequency,type,degree and the duration of each episode were recorded during KD therapy,and Gesell Developmental Scale assessment was respectively performed prior to KD therapy,3,6,12 months after KD therapy.Results The total effective rates in the in-patient group were 60.0％,45.0％,40.0％,respectively after 3,6,12 months of therapy,the retention rates were 80.0％,55.0％,and 40.0％,respectively,and the complete control rate was 30％ ;while the total effective rates in out-patient group were 37.5％,25.0％,and 18.8％,respectively after 3,6,12 months of treatment,the retention rates were 62.5 ％,37.5 ％,18.8％,respectively,and the complete control rate was 12.5 ％ ;the in-patient group showed a significant difference compared with the out-patient group in the clinical efficacy (P ＜ 0.05),two groups had no significant difference in retention rate (P ＞ 0.05),short-time adverse effects in the in-patient group were mainly gastrointestinal reactions and long-term adverse effects were mainly kidney stones,adverse effects in outpatient group were striking;9 patients had cognitive improvement,gross motor (F =3.287,P =0.025) and adaptability (F =8.335,P =0.000) were compared among different groups and the difference was significant.Conclusions KD therapy for children with refractory epilepsy are safe and effective in both out-patients and in-patients;the in-patient group had better efficacy;two groups had no significant difference in retention rate,and the improvement of patient compliance is still an important factor for the success of KD therapy.KD therapy can improve cognitive function of children with refractory epilepsy,mainly in gross motor and adaptability.
