| 摘要: |
| 目的：探讨拉莫三嗪抗癫痫治疗过程中发生药疹及全身性高敏反应时的正确临床处理及提高其再次用药成功率的方法。方法：回顾性分析本院癫痫门诊应用拉莫三嗪治疗癫痫过程中药疹的发生情况及处理结局。 结果：2009年3月至 2014年8月5年半时间本院癫痫专科门诊新诊断的癫痫患者中单独或联合应用拉莫三嗪的242例患儿中，发生药疹共20例，发生率8.3%。20例患儿在第一次发生药疹时一经诊断均立即停药，并视病情分别给予应用抗组胺药氯雷他定和白三烯受体拮抗剂孟鲁司特或用甲泼尼龙和静脉注射免疫球蛋白治疗后病情控制，药疹均于1~2周内消退。其中第一次发生药疹后4例坚决拒绝再次试用拉莫三嗪，16例在严密观察下由微小剂量0.05 mg/(kg·d)起始再次试用拉莫三嗪，结果仅有2例再发生药疹而不再应用拉莫三嗪，其余14例经3个月至6个月逐渐加量最终成功达到目标剂量。结论：从小剂量起始用药可减少拉莫三嗪的药疹发生率；拉莫三嗪治疗过程中发生药疹后及时停药并应用抗组胺药和白三烯拮抗剂治疗，伴有全身性高敏反应者加用大剂量甲强龙及静脉注射免疫球蛋白治疗均可治愈，不留后遗症或危及生命；对于确实需用拉莫三嗪治疗的患者，药疹痊愈后再次从更小剂量起始用药，大部分患者仍可成功保留拉莫三嗪治疗。 |
| 关键词: 拉莫三嗪 药疹 小剂量 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.11.014 |
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| 基金项目: |
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| Discussion of Lamotrigine Drug Rash Treatments and Reintroduction Enhancement Methods |
| Zhou Xiaohua, Chen Jieling, Lin Chuangxin, Cai Xiaoying, Chen Paizhen, Lin Guangyu |
| (The Second Affiliated Hospital of Medical College of Shantou University, Guangdong Shantou 515041, China) |
| Abstract: |
| Objective: To investigate the proper clinical treatments of drug rash and drug hypersensitivity syndrome ( HSS）caused by the use of lamotrigine and methods of enhancing lamotrigine reintroduction success rate. Methods: Retrospective analysis about therapeutic outcome of epilepsy outpatients who occurred drug rash and HSS by using of lamotrigine in our hospital from March 2009 to August 2014. Results: Within this 5.5 years, there were 242 epilepsy outpatients treated lamotrigine exclusively or jointly. And among them, 20 cases ocurred drug rash or HSS, the incidence was 8.3%. The therapy of lamotrigine was discontinued immediately when the drug eruption occurred at the first time, and treated differently according to patient’s condition by applying with antihistamines and leukotriene receptor antagonist therapy, or methylprednisolone and immunoglobulin therapy. All drug rash faded within 1 to 2 weeks. 4 cases refused to retry after the drug eruption occurred for the first time. 16 cases retried lamotrigine treatment begin with tiny doses (0.05 mg/kg-1·d-1) under strict observation, 2 of them reoccured drug rash, and rest of them managed to reach the target dose after 3 to 6 months. Conclusion: Beginning with low dose of lamotrigine could reduce the incidence of drug rash. The drug rash occurred during lamotrigine treatment could be cured without leftover and threat to life by discontinuing the lamotrigine treatment and applying antihistamines and leukotriene receptor antagonist treatment for mild cases, and enhance methylprednisolone dose and apply extra immunoglobulin intravenous injection therapy for HSS cases in time. For most of the patients who do need lamotrgine treatment, it could be reintroduced by beginning with low dose after the drug rash was cured. |
| Key words: lamotrigine drug rash low-dose |
