我国农村地区癫痫治疗管理模式探索及其效果评估  

Exploration and efficacy assessment of the model for epilepsy management in rural China

作　　者：王晓玮[1] 茹小娟[1] 王文志[1] 

机构地区：[1]首都医科大学北京市神经外科研究所,首都医科大学附属北京天坛医院,临床流行病学北京市重点实验室,100050

出　　处：《中华神经科杂志》2016年第5期358-363,共6页Chinese Journal of Neurology

基　　金：中央补助地方卫生事业专项基金资助项目[财社（2004）24号]

摘　　要：目的评价在基层卫生保健基础上开展的癫痫防治管理模式的适用性和有效性。方法采用由各级政府部门领导，各级医疗卫生部门组织，由基层乡（镇）医生进行治疗和随访管理的模式，对24个项目县惊厥性癫痫患者进行筛查和复核，对最终确诊并同意入组的患者给予免费苯巴比妥治疗、随访管理。疗效评估以发作频率与治疗前的变化为标准。结果2011年11月至2013年11月，共有来自408个乡镇卫生院的979名经培训的基层医生参与，共随访管理5038例癫痫患者。管理期间90％以上的患者依从性较好。服用苯巴比妥单药治疗的患者中有3170例患者随访管理满12个月，其中1246例（39．3％）未发作，2005例（63．3％）发作次数减少50％以上；651例患者随访管理满24个月，其中202例（31．0％）未发作，491例（75．4％）患者发作次数减少50％以上。管理期间343例（6．8％）患者退组，仅有35例（0．7％）因不良反应严重退出治疗。69例（1．4％）患者死亡，8例因癫痫发作导致死亡，占总死亡人数的11．6％。结论癫痫防治管理模式以经济有效的措施控制了农村癫痫患者的发作，适宜在我国广大农村进行推广。Objective To evaluate the applicability and effectiveness of the model for managing patients with convulsive epilepsy in rural China. Methods The model is under leadership of the government departments and medical institutions at all levels organized primary physicians for treatment and management. People with convulsive epilepsy in 24 rural areas were screened by local physicians and confirmed by neurologists. Patients diagnosed with convulsive epilepsy and agreed with managing were recruited into study. They were managed at primary care level and provided with phenobarbital monotherapy. Efficacy was assessed from the changes in seizure frequencies from baseline. Results There were 408 town hospitals and 979 trained primary care physicians participating in our study. Five thousand and thirty-eight patients were enrolled in 2 years, and 90% patients with good compliance. Among the people who were treated with phenobarbital monotherapy, 3 170 were managed for 12 months, and 2 005 （63.3%）of whom had a 50% or greater reduction in seizure frequency and 1 246 （39.3%）patients remained seizure free; 651 patients were managed for 24 months, and 491 （75.4%）of whom had a 50% or greater reduction in seizure frequency and 202 （31.0% ）patients remained seizure free. Three hundred and forty-three （6. 8% ） patients withdrew from the study, and only 35 （0. 7% ） patients discontinued treatment because of side effects. Sixty-nine （1.4%） patients were dead and 8 （11.6%） of them were caused by status epilcpticus. Conclusion This study confirms that this model is beneficial to patients with epilepsy and is suitable to the rural areas of China.

关 键 词：癫痫 疾病管理 初级卫生保健 苯巴比妥 

分 类 号：R742.1[医药卫生—神经病学与精神病学]