目的 比较5种抗癫痫药(AEDs)单药治疗初诊儿童癫痫患者的2 a单药保留率,为儿童癫痫患者的药物选择提供参考.方法 采用前瞻性登记队列研究方法,选择2002年1月至2012年1月初诊儿童癫痫患者564例,根据患儿首次选用AEDs名称将患儿分为5组,即卡马西平(CBZ)组、丙戊酸(VPA)组、托吡酯(TPM)组、奥卡西平(OXC)组和拉莫三嗪(LTG)组,通过门诊随访患者的停药时间及停药原因,比较其6、12和24个月的单药保留率.结果 6个月单药保留率OXC组患儿为82.98％,LTG组患儿为79.69％,TPM组患儿为68.49％,CBZ组患儿为51.15％,VPA组患儿为46.18％;12个月单药保留率LTG组患儿为76.56％,OXC组患儿为74.47％,TPM组患儿为61.64％,CBZ组患儿为42.75％,VPA组患儿为42.17％;24个月单药保留率LTG组患儿为71.88％,OXC组患儿为61.70％,TPM组患儿为60.27％,CBZ组患儿为41.22％,VPA组患儿为40.56％.6、12、24个月单药保留率LTG组、OXC组、TPM组患儿均明显高于CBZ组和VPA组(P＜0.05),但LTG组、OXC组、TPM组患儿之间单药保留率比较差异无统计学意义(P＞0.05).停药原因上,因依从性差停药患儿占40.79％,因疗效不佳停药患儿占38.63％,这是导致患儿停药的2个主要原因.结论 LTG、OXC和TPM比较适合作为儿童癫痫治疗的首选药物,导致患儿停药的主要原因是药物疗效不佳和依从性差.

Objective To investigate the associated risk factors of the delayed encephalopathy after acute carbon mon-oxide poisoning (DEACMP) .Methods Seven hundred and fifty-two cases of acute carbon monoxide poisoning (ACMP) in-patients admitted to 10 hospitals in northern Henan during 2001 -2014 who met the inclusive and exclusive criteria were re-cruited .The clinical information of each ACMP patient was collected ,and following-up for each patient was more than 90 days .Based on the occurrence of DEACMP ,the patients were divided into ACMP group and DEACMP group .The statistical induction of 26 indicators in each patient ,such as age ,coma duration ,severity of coma ,smoking & drinking ,etc .was con-ducted to analyze the possible risk factors of DEACMP in ACMP patients .Results One hundred and twenty-seven out of 752&nbsp;patients demonstrated DEACMP ,the univariate analysis showed that male ACMP patients were more susceptible to DEACMP than female patients ,and the difference was statistically significant (P<0 .05) .When the coma duration was >12 h ,the inci-dence of DEACMP significantly increased ,and up to 58 .3% once the coma last for >48 h .The patients who had moderate-a-bove coma ,positive pathology ,being widowed ,history of smoking and drinking ,major mental stimulation was more suscepti-ble to DEACMP than those without above issues ,and the differences were all statistically significant (All P<0.05) .The pa-tients whose brain CT showed abnormalities at the acute stage of ACMP ,or who exhibited coexistence of other diseases were more likely to suffer from DEACMP ,the difference was statistically significant (P<0 .05) .Multivariate regression analysis showed that the gender ,history of being widowed ,abnormal brain CT ,the severity of coma ,coma duration were the inde-pendent risk factors of DEACMP .Conclusion There are multiple risk factors for DEACMP ,especially for the ACMP pa-tients who are over 40 years old ,male with a history of being widowed ,abnormal brain CT ,moderate-above coma ,coma du-ration >12 h .Additional care has to be taken for their clinical monitoring to take premorbid preventive treatment as early in-tervention to the disease .

Objective:To explore the value of 24 hours’ambulatory electroencephalogram(AEEG) monitoring the treatment of epilepsy .Methods:187 patients with epilepsy received clinical and electroen‐cephalogram diagnosis formal antiepileptic drugs therapy .Regular subsequent examinations and AEEG or REEG monitoring were also made during the two years of follow‐up to observe the consistent rate of clin‐ical efficacy and EEG results .Results:The consistent rate of AEEG and clinical curative effect was 62 .1%for the first year’s follow‐up ,70 .5% for the second year ,and REEG was 81 .5% for the first year and 85 .9% for the second ,The proportion of normal REEG results during controlled clinical seizures was much higher than that of AEEG while the proportion of no improved REEG results during controlled clin‐ical seizures was much lower than that of AEEG .They were statistically significant(P<0 .01) .Among the inconsistent of AEEG and clinical efficacy ,89 .3% ~ 94 .5% was clinical seizure controlled or im‐proved while AEEG result was not improved .Conclusion:AEEG monitoring can provide an objective basis in the judging of clinical curative effect of epilepsy .Patients with epilepsy should take regular AEEG mo‐nitoring during the antiepileptic drugs therapy .

Background Drug therapy is the major treatment of epilepsy. As a common evaluation index,the drug retention rate comprehensively reflects the extent of patient′s recognition to the drug therapy. The recent studies were mostly focused on short-term retention rate of anti-epileptic drugs( AEDs),it is important to explore the long-term retention rate of AEDs. Objective To compare the two - year retention rate of five AEDs monotherapy for patients with newly diagnosed epilepsy. Methods 736 cases with nwely diagnosed epilepsy who were treated in Department of Neurology of the Second Affiliated Hospital of Xinxiang Medical University from January 1993 to January 2012 , were selected as study subjects, they received carbamazepine( CBZ ), valproic acid ( VPA ), topiramate ( TPM ), oxcarbazepine ( OXC ) and lamotrigine ( LTG ) monotherapy,respectively,divided to CBZ group, VPA group, TPM group, OXC group and LTG group. The informations such as retention rate, epileptic seizure, adverse reactions and the reasons for drug withdrawal were obtained by means of outpatient follow- up and telephone follow - up. Results After two years of treatment,among 736 cases,560 cases still received the original drug monotherapy,the total retention rate was 76. 1%,the retention rate of LTG,OXC,TPM,VPA,and CBZ was 85. 9% ( 67/78 ), 78. 6% ( 44/56 ), 77. 7% ( 80/103 ), 74. 4% ( 218/293 ) and 73. 3% ( 151/206 ), respectively. The retention rate of LTG was significantly different from that of CBZ and VPA,respectively(P<0. 05),there was no significant difference in the retention rate among the other drugs(P>0. 05). There were significant differences in two-year retention rate of AEDs monotherapy among five groups of pediatric epileptic patients( P <0. 05 );there was no significant difference in two-year retention rate of AEDs monotherapy among five groups of adult epileptic patients( P>0. 05 ) . After two years of treatment,there was no significant difference in the clinical curative effect among five groups of patients(H=7. 426,P=0. 115). The primary cause of drug withdrawal was poor compliance,followed by ineffective treatment. Conclusion The two-year retention rate of LTG monotherapy was the highest among those of five drugs. There was no significant difference in efficacy among the five antiepileptic drugs. The main reason of drug withdrawal was poor compliance, which could provide detailed reference for the clinical therapy of epilepsy in Chinese patients.

临床资料 患者,男性,76岁,因"活动后喘憋1周"入院.既往有高血压病史30余年,半年前患"脑梗塞",经治疗后恢复.查体:BP 130/80 mmHg,神志清,肥胖,唇紫绀,颈静脉充盈,两肺呼吸音低,无干湿罗音,HR 85次/min,心脏查体无异常,肝脾触诊不大,双下肢无浮肿.