摘要
目的分析儿童难治性癫痫生酮饮食(KD)治疗的依从性与安全性。方法 2011年5月至2012年12月复旦大学附属儿科医院收治经KD治疗并随访的癫痫患儿83例,其中男49例、女34例;均确诊为难治性癫痫且符合KD治疗适应证;经过医院多学科KD专病专项治疗管理模式,所有病例均进行至少3～6个月随访,分析KD治疗依从性与安全性。结果 (1)不同疗程KD治疗时间保留率:随访第5天保留率为92.8%(77/83)、随访第3个月为70.7%(53/75)、随访第6个月为57.1%(32/56)。(2)依从性分析:26例停止KD治疗的主要因素包括疗效不满意为27%(7/26)、患儿拒绝KD饮食为19%(5/26)、患儿家属依从性因素为15%(4/26)、患儿感染或意外死亡因素均为12%(3/26)等,随访第5天停用原因与患儿食用KD饮食的依从性和患儿家属执行KD治疗的依从性有关,随访第3个月停用原因与疗效和KD治疗期间感染停用有关,随访第6个月KD停用与营养指标检测异常有关。(3)安全性分析:随访第5天KD治疗副反应主要表现在嗜睡、乏力、胃肠道不耐受及血脂异常等;随访第6个月胃肠道耐受情况好转,主要副反应集中在血脂异常。3例死亡(与KD治疗无关)。结论儿童难治性癫痫KD治疗多数患儿依从性与耐受性好,多学科专病管理有利于儿童KD治疗。
Objective To evaluate the compliance and safety of the ketogenic diet （KD） in children with intractable epi- lepsy. Methods This was a prospective, open-label study of intractable epilepsy patients treated with the classic KD with a lipid-to-nonlipid ratio 4：1.83 of cases （49 males and 34 females） , who were managed and followed-up through muhidisciplinary KD special group from May 2011 to December 2012.The variables related to the compliance and safety were also analyzed. Results ①At 5 days,3 and 6 months after initiation,92.8%（77/83） ,70.7%（53/75） ,and 57.1% （32/56） patients remained on the diet.②The main causes to stop the treatment of 26 cases included poor efficacy ac- counting for 27% （7/26）, the children＇ s rejection for KD accounting for 19% （5/26）, a poor compliance of parents ac- counting for 15% （4/26）, the infection and accidental death 12% （3/26） .The cause of treatment discontinued was the non- compliance of the patients or the parents in the early days ; inefficiency and the infection were the main causes to stop the therapy in the near future; the stopping of treatment according to abnormal nutrition indicators in long-term.③The side effect was drowsiness, fatigue, intolerance of gastrointestinal tract and abnormal blood lipids in the early days.The tolerance of gastrointestinal tract got better in the near future, and the main side effect was the abnormal blood lipids in this period. Three dead cases were not relative with KD. Conclusion The KD is a safe and effective alternative therapy for intractable childhood epilepsy.Muhidisciplinary KD special group is beneficial to children with KD treatment.
出处
《中国实用儿科杂志》
CSCD
北大核心
2013年第5期378-381,共4页
Chinese Journal of Practical Pediatrics
关键词
生酮饮食
难治性癫痫
依从性
安全性
ketogenic diet
intractable epilepsy
compliance
safety
