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外科研究与新技术（中英文）

外科研究与新技术 ›› 2016, Vol. 5 ›› Issue (3): 165-168.

• 论著 • 上一篇    下一篇

丙戊酸钠对重型颅脑损伤患者手术后发生癫痫的预防作用研究

王勇   

  1. .甘肃酒泉市人民医院
  • 收稿日期:2016-04-21 修回日期:2016-05-04 出版日期:2016-09-28 发布日期:2016-10-27
  • 通讯作者: 王勇 E-mail:whtcsttg@163.com

  • Received:2016-04-21 Revised:2016-05-04 Online:2016-09-28 Published:2016-10-27

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摘要： 目的 探究并分析丙戊酸钠对重型颅脑损伤患者手术后发生癫痫的预防作用。方法 选取我院自2012年—2015年收治的重型颅脑损伤患者60例，按照随机数字表法将其平均分为观察组和对照组，每组30例。观察组患者术前给予丙戊酸钠治疗，而对照组患者未给予丙戊酸钠。于手术前后对患者进行神经认知功能测评，观察并分析检验结果。结果 经秩和检验，两组患者术后癫痫发生情况差异明显（u=2.35，p<0.05），观察组仅有1例发生局脑性发作，对照组以全脑性发作为主，且总发生率明显高于对照组（X2=4.21，p<0.05），具有统计学意义。两组患者手术前后MoCA得分组间、组间.多时间点、多时间点比较差异具有统计学意义（F=11.535，P=0.001、F=5.835，P=0.02、F=4.921，P=0.03），随着时间推移，两组患者认知功能均有明显改善，但术后3m观察组患者MoCA得分明显高于对照组（P<0.05），具有统计学意义。随访过程中，术后3d内，观察组患者1例发生腹泻，2例发生恶心呕吐，2例头痛，随后的3个月的随访中未见血小板严重减少以及胰腺炎和急性肝坏死发生，与对照组患者相比无明显差异（p<0.05），不具有统计学意义。结论 对于重症颅脑损伤患者，术前给予丙戊酸钠能有效预防癫痫的发生，并减少术后患者的神经认知功能的下降，值得临床广泛推广。

关键词: 丙戊酸钠, 颅脑损伤, 癫痫, 认知功能

Abstract: Objective To explore and analyze the preventive effect of sodium valproate on epileptic patients with severe traumatic brain injury after operation. Methods 60 cases of severe craniocerebral injury patients in our hospital from December 2014 to December 2015, were randomly divided into observation group and control group, 30 cases in each group. The observation group received preoperative valproate treatment, and patients in the control group were not given valproate. Before and after the operation of neurocognitive assessment of patients, observation and analysis of the test results. Results the rank sum test, two groups of patients with postoperative epilepsy (u=2.35, P < 0.05) difference obvious. Observation group only 1 case of cerebral attack and control group with cerebral attack primarily, and always occur rate was significantly higher than that of the control group (P < 0.05, X2=4.21), with statistical significance. The two groups of patients before and after the operation MOCA scores between groups and between groups. Multi time, multi time difference has statistical significance (F=11.535, P = 0.001, F=5.835, P = 0.02, F=4.921, P = 0.03), with the passage of time, the cognitive function of patients in two groups were significantly improved, but the postoperative 3M observation group MOCA score was significantly higher than that of control group (P < 0.05), with statistical significance. During follow-up, within 3 days after the operation to observe group 1 patients with diarrhea, nausea and vomiting occurred in 2 cases, 2 cases of headache, subsequent follow-up of 3 months and no severe thrombocytopenia and pancreatitis and acute liver necrosis, and with patients in the control group had no significant difference (P < 0.05), does not have statistical significance. Conclusion for the patients with severe craniocerebral injury, preoperative given sodium valproate can effectively prevent epilepsy, and reduce neurocognitive function in patients with decreased after surgery, is worthy of clinical application.