拉莫三嗪对脑外伤术后患者认知功能及癫痫的作用研究  

Effects of lamotrigine on cognitive function and epilepsy in patients after brain craniocerebral surgery

作　　者：许琼冠 李强 徐鹏翔 付宙锋 Xu Qiongguan;Li Qiang;Xu Pengxiang;Fu Zhoufeng(Department of Neurosurgery,the Second Affiliated Hospital of Hainan Medical University,Haikou,Hainan,570311,China)

机构地区：[1]海南省医学院第二附属医院神经外科,海口570311

出　　处：《西南国防医药》2018年第11期1004-1006,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的比较拉莫三嗪与丙戊酸钠对重症颅脑外伤术后患者认知功能及创伤性癫痫发生的防治作用。方法选取500例重症颅脑外伤患者作为研究对象,按照入院时间先后分为丙戊酸钠组和拉莫三嗪组,各250例,均行开颅减压术治疗。实施手术前,拉莫三嗪组口服拉莫三嗪,丙戊酸钠组口服丙戊酸钠治疗,持续服用1个月。比较两组术后的认知功能和创伤性癫痫及不良反应发生率。结果两组术后不同时点的MMSE量表评分均明显高于术前(P <0.01),且拉莫三嗪组的评分均显著高于丙戊酸钠组(P <0.01)。拉莫三嗪组晚期创伤性癫痫的发生率仅为4.8%,明显低于丙戊酸钠组的18.4%发生率(P <0.01)。丙戊酸钠组的不良反应总发生率为32.8%,明显高于拉莫三嗪组的14.4%(P <0.01)。结论重症颅脑外伤患者手术前开始口服拉莫三嗪,能明显促进患者术后认知功能的恢复,降低创伤性癫痫的发生率,且安全性高,值得在临床进一步推广。Objective To compare the effects of lamotrigine and sodium valproate on the cognitive function and in the prevention of post-trauumatic epilepsy in patients after craniocerebral trauma surgery. Methods A total of 500 patients with severe eranioeerebral trauma were selected as study subjects and were divided into a sodium valproate group and a lamotrigine group （n= 250, respectively） according to the time of adnfission. The two groups were treated with deeompressive cranieetomy. Before the operation, the lamotrigine group orally took lamotrigine, and sodium valproate group orally took sodium valproate. The drugs were ceaselessly taken for one month. The postoperative cognitive function and the incidence of post-traumatic epilepsy and adverse reactions were compared between the two groups. Results The MMSE scale scores at different postoperative time points were significantly higher than those before the surgery （P 〈 0.01）, and the scores in the lamotrigine group were significantly higher than those in the sodium valproate group （P 〈 0.01）. The incidence of advanced post-traumatic epilepsy in the lamotrigine group was as low as 4.8%, which was significantly lower than the 18.4% in the sodium valproate group （P 〈 0.01）. The total incidence of adverse reactions in sodium valproate group was 32.8%, which was significantly higher than the 14.4% in the lamotrigine （P 〈 0.01）. Conclusion The oral administration of lamotrigine by patients with severe eranioeerebral trauma before operation can significantly promote the recovery of patients＂ postoperative cognitive function, reduce the incidence of post-traumatic epilepsy, has high safety-, and is worthy of further promotion in clinical practice.

关 键 词：重症颅脑外伤 拉莫三嗪 丙戊酸钠 认知功能 创伤性癫痫 

分 类 号：R749.12[医药卫生—神经病学与精神病学]