生酮饮食治疗超难治性癫痫持续状态PICU病儿短期疗效探讨  

The feasibility and effectiveness of ketogenic diet for super refractory status epilepticus in children in pediatric intensive care unit

作　　者：杨炯贤[1] 樊超男[2] 刘珺[2] 李峥[2] 贾鑫磊[2] 高恒妙[2] 钱素云[2] YANG Jiong-xian;FAN Chao-nan;LIU Jun;LI Zheng;JIA Xin-lei;GAO Heng-miao;QIAN Su-yun(Department of Health Care Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心首都医科大学附属北京儿童医院保健中心,北京100045 [2]国家儿童医学中心首都医科大学附属北京儿童医院重症医学科,北京100045

出　　处：《肠外与肠内营养》2023年第3期129-134,共6页Parenteral & Enteral Nutrition

基　　金：国家临床重点专科建设项目;北京市重大疫情防治重点专科卓越类项目。

摘　　要：目的:分析生酮饮食(KD)在超难治性癫痫持续状态(SRSE)病儿中应用的有效性、耐受性。方法:回顾分析北京儿童医院重症监护室2018年6月至2022年5月期间收治的SRSE应用生酮饮食治疗病儿的一般情况(性别、年龄、体质量)、实验室检查(肝功能、肾功能、血脂、血糖)、KD方案(方案的比例及组成)、能量供给(起始能量供给和能量供给目标)等,对生酮饮食治疗的有效性和临床相关副作用进行总结。结果:符合SRSE诊断标准并接受生酮饮食且符合纳入标准者病儿20例,其中男孩11例,年龄2岁2月至13岁1月,平均(85.8±31.6)月。生酮饮食前应用抗癫痫药物4-6种。本组20例SRSE病儿中存活18例,存活率为90.0%,观察终点时有效率为60.0%。KD治疗的副作用有胃肠耐受不良发生2例(10.0%)、肾结石1例(5.0%)和严重高脂血症1例(5.0%)等。本研究中观察终点时的血脂水平基本回落到KD前水平,与KD启动前无统计学差异(P>0.05)。结论:KD参与治疗SRSE病儿中,抽搐缓解率达到60.0%,临床耐受性良好。SRSE病儿若无KD实施的禁忌症可尽早启动KD。Objective:This study aimed to investigate the effectiveness of a ketogenic diet(KD)for super refractory status epilepticus(SRSE)in the pediatric intensive care unit(PICU).Method:A retrospective analysis was performed on children with SRSE treated with KD in PICU from June 2018 to May 2022.The retrospective contents covered general conditions,ketogenic diet KD and energy supply,frequency of seizures and management of clinically relevant side effects during ketogenic diet therapy.Results:A total of 20 children(11 boys)met all the criteria and were analyzed.The average age was(85.8±31.6)months.4-6 kinds of antiepileptic drugs before ketogenic diet.Among the 20 children with SRSE,the survival rate was 90.0%and the effective rate was 60.0%.The side effects of KD treatment included gastrointestinal intolerance in 2 cases(10.0%),kidney stone in 1 case(5.0%)and severe hyperlipidemia in 1 case(5.0%).During hospitalization,blood lipids of the children basically fell back to the level before ketogenic diet in endpoints for observation.Conclusion:KD may be effective for treatment of SRSE in the PICU.It is recommended to start the ketogenic diet as early as possible.Randomized controlled studies can further confirm the efficacy and safety of KD treatment in children with SRSE.

关 键 词：生酮饮食 超难治性癫痫持续状态 儿童 

分 类 号：R459.3[医药卫生—治疗学] R742.1[医药卫生—临床医学]