应用苯巴比妥治疗中国农村地区2455例癫癎患者效果评估  

Evaluation of the efficacy of phenobarbital in treatment of epilepsy in rural areas: study of 2455 patients in rural China

作　　者：王文志[1] 吴建中[1] 戴秀英[2] 王太平 杨斌[4] 马广玉 袁成林[6] 洪震[7] 赵东海[1] 

机构地区：[1]北京市神经外科研究所,100050 [2]宁夏医学院 [3]山西晋城市泽州县医院神经内科 [4]河南焦作市人民医院神经内科 [5]黑龙江省牡丹江市博爱老年医院神经内科 [6]江苏省苏北人民医院神经内科 [7]上海复旦大学神经病学研究所流行病室

出　　处：《中华医学杂志》2006年第19期1297-1300,共4页National Medical Journal of China

基　　金：世界卫生组织基金资助项目(WHO/MSD/MBD/00.11)

摘　　要：目的探讨在我国农村社区人群中,利用乡村医生负责治疗管理惊厥型癫患者的可行性。方法选择我国黑龙江省牡丹江市东宁县和穆棱县、宁夏吴忠市利通区和青铜峡市两个县、山西晋城市泽州县、河南焦作市武陟县、江苏扬州市邗江县、上海市金山区等6省8个县开展癫防治研究。由经过短期培训的乡卫生院医生负责筛查惊厥型癫患者,经神经科医师核查确诊,符合入选标准者进入治疗管理组。乡卫生院医生按规定方案使用苯巴比妥治疗、定期随访和管理患者。结果6个省示范区在2002—2004年2年半的时间内共有2455例惊厥型癫患者进入观察组接受苯巴比妥治疗。其中347例(26·2%)在开始治疗后2年内无发作,415例(31·3%)发作次数较入组前减少75%以上。无变化和加重者约占21%;在开始服药的前3个月中,有困倦嗜睡、头晕等轻度不良反应者占26·1%,中度不良反应占3·7%,重度为0·3%。6个省总样本中共有597例由于各种不同原因先后退组,占入组病例总数的24·3%。结论研究表明,经过短期培训的乡卫生院医生可以担负起治疗管理农村地区癫患者的任务。苯巴比妥治疗惊厥型癫癎发作效果良好,且少见严重不良反应。示范项目取得的经验适宜向我国广大农村地区和条件近似的发展中国家推广。Objective To evaluate the efficacy of phenobarbital in treatment of patients with convulsive forms of epilepsy in rural areas and to develop a suitable relevant model for rural China. Methods A demonstration protocol was conducted in the rural areas of 8 counties from 6 provinces and municipality in China, Heilongjiang, Ningxia, Henan, Jiangsu, Shanxi, and Shanghai from December 2001 to June 2004. Epidemiologieal investigation of the prevalence and treatment gap of epilepsy was carried out. Patients with convulsive forms of epilepsy thus screened underwent treatment of phenobarbital. Physicians of township hospitals received short-term training to be in charge of the treatment and regular follow-up of the patients. Results A total of 2455 patients with generalized tonie-elonie seizures in these 6 rural areas were screened and entered the treatment group. 347 patients （26.2%） had been seizure-free during the period of these 2 years, 415 patients （31.3%） had their seizure frequencies decreased by 〉75% as compared with those during the period of 6 months before treatment, and the conditions of 26.1% of the patients did not change or even became worse. About 26.1% of the patients had mild side effects, 3.7% had moderate side effects, and only 0.3% had severe side effects when the dosage of phenobarbital in the first 3 months was increased. 597 patients （24.3%） withdrew from the treatment group because of various reasons. Conclusion This protocol was suitable to the rural areas of China. The trained physicians are capable of fulfilling the task to treat the patients with epilepsy. Phenobarbital is an effective drug for most patients with convulsive seizures and has no severe side effect.

关 键 词：苯巴比妥 癫癎 干预性研究 乡村医生 

分 类 号：R742.1[医药卫生—神经病学与精神病学]