李俊毅

[摘要] 目的 探討丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫的临床效果。 方法 回顾性分析陕西省铜川市人民医院2014年2月～2017年3月收治的脑卒中后癫痫患者90例的临床资料，依据治疗方式的不同将其分为对照组和观察组，每组45例。对照组给予丙戊酸钠，观察组给予丙戊酸钠联合左乙拉西坦。观察并比较两组患者治疗前后癫痫发作次数、发作持续时间、痫样放电、累及导联数和神经元特异性烯醇化酶（NSE）、肿瘤坏死因子-α（TNF-α）、白细胞介素-2（IL-2）、白细胞介素-6（IL-6）水平，以及临床疗效、不良反应情况。 结果 两组患者治疗前癫痫发作次数、发作持续时间、痫样放电、累及导联数和NSE、TNF-α、IL-2、IL-6水平比较差异无统计学意义（P > 0.05）。治疗后两组患者癫痫发作次数、发作持续时间、痫样放电、累及导联数和NSE、TNF-α、IL-2、IL-6水平均明显低于治疗前（P < 0.05），且观察组均明显低于对照组（P < 0.05）。观察组总有效率明显高于对照组，差异有统计学意义（P < 0.05）。两组患者皮疹、头痛、嗜睡、恶心呕吐、感觉异常等不良反应发生率比较差异无统计学意义（P > 0.05）。结论 丙戊酸钠联合左乙拉西坦治疗脑卒中后癫痫患者可以改善临床症状，提高临床效果，值得临床推广应用。

[关键词] 丙戊酸钠；左乙拉西坦；脑卒中；癫痫

[中图分类号] R742.1 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0109-04

[Abstract] Objective To explore the clinical effect of Sodium Valproate combined with Levetiracetam in the treatment of epilepsy after stroke. Methods The clinical data of 90 cases of patients with epilepsy after stroke admitted to Tongchuan People's Hospital from February 2014 to March 2017 was analyzed retrospectively and the patients were divided into control group and observation group by different treatments， with 45 cases in each group. The control group was treated with Sodium Valproate， the observation group was treated with Sodium Valproate combined with Levetiracetam. The seizures number， generalized seizure duration， epileptiform discharges， involved lead number， levels of neuron-specific enolase （NSE）， tumor necrosis factor-α （TNF-α）， interleukin-2 （IL-2） and interleukin-6 （IL-6）， clinical efficacy and adverse reactions of two groups before and after treatment were observed and compared. Results Before treatment， there were no significant differences in the seizures number， generalized seizure duration， epileptiform discharges， involved lead number， and NSE， TNF-α， IL-2 and IL-6 levels between the two groups （P > 0.05）. After treatment， the seizures number， generalized seizure duration， epileptiform discharges， involved lead number， NSE， TNF-α， IL-2 and IL-6 levels of two groups were lower than those before treatment （P < 0.05）， which of the observation group were significantly lower than those of the contol group （P < 0.05）. The total effective rate of observation group was higher than that of control group， the difference was statistically significant （P < 0.05）. There were no significant differences in the incidence of adverse reactions of rash， headache， drowsiness， nausea and vomiting， paresthesia between the two groups （P > 0.05）. Conclusion Sodium Valproate combined with Levetiracetam in the treatment of patients with epilepsy after stroke can improve clinical symptoms and clinical effect， which is worthy of clinical promotion.

[Key words] Sodium Valproate； Levetiracetam； Stroke； Epilepsy

脑卒中继发性癫痫属于脑卒中的严重并发症，是常见的神经系统疾病，有资料显示，>60岁的癫痫患者中，脑卒中后癫痫比例较高，约占40%[1-2]。目前脑卒中后癫痫发病机制不是十分明确，可能是脑卒中诱发神经元损伤，进而成为引发癫痫的致痫灶。神经系统受到损伤后，免疫系统多处于活化状态，炎性细胞因子分泌失衡，造成局部神经组织的异常性放电。脑卒中后癫痫可能加重神经功能临床症状和脑组织损伤，进而对患者预后水平造成影响[3-4]。一……