丙戊酸钠与苯妥英钠治疗癫痫持续状态的系统评价

Curative Effect of Sodium Valproate and Phenytoin on Status Epilepticus: A Systematic Review

关键词:  癫痫持续状态  丙戊酸钠  苯妥英钠  随机对照实验  系统评价

Key words:  status epilepticus  sodium valproate  phenytoin  randomized controlled trial  cochrane systematic review

摘要:

目的 系统评价丙戊酸钠与苯妥英钠治疗癫痫持续状态的疗效。方法 计算机检索Medline、Embase、PubMed图书馆、中文期刊全文数据库(CNKI)、万方数据库和维普等数据库(检索时限均从建库至2013年9月)，收集国内外关于丙戊酸钠与苯妥英钠片治疗癫痫的随机对照实验。按照Cochrane 系统评价的要求，制定纳入与排除标准，由3名研究者独立进行纳入研究的方法学质量评价和有效数据提取，采用RevMan 5.2软件进行Meta分析。结果 共纳入6个RCT，430例患者。Meta分析结果显示，丙戊酸钠组与苯妥英钠组在癫痫控制有效率方面效果类似[P=0.56>0.05，OR=1.14，95%CI=(0.73，1.76)]；丙戊酸钠组与苯妥英钠组在治疗癫痫的复发率方面效果也类似[P=0.91>0.05，OR=0.97，95%CI=(0.54，1.72)]。结论 当癫痫患者进行治疗时，可以考虑选用丙戊酸钠或苯妥英钠进行治疗。受纳入研究数量及质量限制，本系统评价结果尚需更多高质量、大样本、多中心随机对照实验验证。

Abstract:

OBJECTIVE To assess the curative effect of sodium valproate and phenytoin on status epilepticus(SE). METHODS Randomized controlled trials of sodium valproate and phenytoin for patients with SE in the database of the Medline, Embase, PubMed, CNKI, VIP and Wanfang database were collected. Inclusion and exclusion criteria was established according to the criteria recommended by the Cochrane Handbook for Systematic Reviews, and the datas were extracted independently from all the trails by three reviewers. Meta-analysis was performed by Rev Man 5.2 software. RESULTS A total of 6 RCTs involving 430 patients with SE were included. The incidence of SE control in the sodium valproate group was similar to that in the phenytoin group[P=0.56>0.05, OR=1.14, 95%CI=(0.73,1.76)]; the incidence of SE recur control in the sodium valproate group was also similar to that in the phenytoin group[P=0.91>0.05, OR=0.97, 95%CI=(0.54, 1.72)]. CONCLUSION It is considerable to use sodium valproate or phenytoin in the treatment of SE if necessary. Due to the limitation of both quantity and quality of included studies, this conclusion should be further conformed with more high quality and large sample studies.