氟桂利嗪分别联合普萘洛尔与托吡酯治疗偏头痛的临床价值分析
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摘要
目的对比氟桂利嗪联合普萘洛尔与氟桂利嗪联合托吡酯治疗偏头痛的临床效果。方法选取2016年7月至2018年2月收治的偏头痛患者92例为研究对象,以随机数字表法分为观察组46例,对照组46例,观察组应用氟桂利嗪联合托吡酯治疗,对照组应用氟桂利嗪联合普萘洛尔治疗,观察两组治疗前、治疗3个月后头痛改善情况、脑血管血流情况,治疗后脑电图(EEG)变化及用药期间不良反应发生情况。结果治疗前两组头痛情况差异无统计学意义(P>0.05),治疗后均有改善,观察组治疗3个月后头痛发作频率、头痛程度及头痛持续时间与同期对照组对比,P<0.05;治疗前两组脑血流情况差异无统计学意义(P>0.05),治疗后均有好转,观察组治疗3个月后基底动脉(BA)、椎动脉(VA)、大脑中动脉(MCA)血流速度与同期对照组对比,P<0.05;观察组治疗后EEGθ波增多、δ波增多、α波频率变慢比率分别为54.35%、63.04%、80.43%,与对照组30.43%、39.13%、58.70%对比,差异有统计学意义(P<0.05);观察组用药期间不良反应发生率为19.57%,同对照组39.13%对比,明显减少,P<0.05。结论相比于氟桂利嗪联合普萘洛尔,氟桂利嗪联合托吡酯能明显减少头痛发作次数,缩短头痛持续时间,减轻头痛程度,对患者脑血管血流及异常神经元放电改善作用显著,且安全性较高,更值得推广。
Objective To compare the clinical effects of flunarizine combined with propranolol and flunarizine combined with topiramate in the treatment of migraine. Method 92 patients with migraine admitted from Jul 2016 to Feb 2018 were selected as the subjects, they were randomly divided into 46 cases in the observation group and 46 cases in the control group.The observation group was treated with flunarizine combined with topiramate,and the control group was treated with flunarizine combined with propranolol. The improvement of headache, cerebral blood flow before and 3 months after treatment, the changes of electroencephalogram(EEG) after treatment and adverse reactions during the medication were observed in the two groups. Results There was no significant difference in headache between the two groups before treatment(P>0.05), all had improvement after treatment. The frequency of headache, the degree of headache and the duration of headache in the observation group were compared with the control group at 3 months after treatment, P<0.05; There was no significant difference in cerebral blood flow between the two groups before treatment(P>0.05), all had improvement after treatment, the blood flow velocity of basilar artery(BA), vertebral artery(VA), middle cerebral artery(MCA) after 3 months of treatment in the observation group was compared with the control group, P<0.05; In the observation group, the ratios of increased EEGθ wave, increased δ wave, and slower frequency of α wave after treatment were 54.35%, 63.04%, 80.43%,respectively, compared with 30.43%, 39.13%, 58.70% in the control group, the difference was statistically significant(P<0.05); The incidence of adverse reactions during the medication in the observation group was 19.57%, compared with 39.13% in the control group, P<0.05. Conclusion Compared with flunarizine combined propranolol,flunarizine combined with topiramate can significantly reduce the number of headache attacks, shorten the duration of headache, reduce the degree of headache, and improve the cerebral blood flow and abnormal neuronal firing of the patients significantly, it is more safe and more worth promoting.
Objective To compare the clinical effects of flunarizine combined with propranolol and flunarizine combined with topiramate in the treatment of migraine. Method 92 patients with migraine admitted from Jul 2016 to Feb 2018 were selected as the subjects, they were randomly divided into 46 cases in the observation group and 46 cases in the control group.The observation group was treated with flunarizine combined with topiramate,and the control group was treated with flunarizine combined with propranolol. The improvement of headache, cerebral blood flow before and 3 months after treatment, the changes of electroencephalogram(EEG) after treatment and adverse reactions during the medication were observed in the two groups. Results There was no significant difference in headache between the two groups before treatment(P>0.05), all had improvement after treatment. The frequency of headache, the degree of headache and the duration of headache in the observation group were compared with the control group at 3 months after treatment, P<0.05; There was no significant difference in cerebral blood flow between the two groups before treatment(P>0.05), all had improvement after treatment, the blood flow velocity of basilar artery(BA), vertebral artery(VA), middle cerebral artery(MCA) after 3 months of treatment in the observation group was compared with the control group, P<0.05; In the observation group, the ratios of increased EEGθ wave, increased δ wave, and slower frequency of α wave after treatment were 54.35%, 63.04%, 80.43%,respectively, compared with 30.43%, 39.13%, 58.70% in the control group, the difference was statistically significant(P<0.05); The incidence of adverse reactions during the medication in the observation group was 19.57%, compared with 39.13% in the control group, P<0.05. Conclusion Compared with flunarizine combined propranolol,flunarizine combined with topiramate can significantly reduce the number of headache attacks, shorten the duration of headache, reduce the degree of headache, and improve the cerebral blood flow and abnormal neuronal firing of the patients significantly, it is more safe and more worth promoting.
引文
[1]Haut S R,Lipton R B.Migraine and epilepsy:progress towards preemptive therapy[J].Epilepsy Behav,2013,28(2):241-242.
[2]中华医学会疼痛学分会头面痛学组,中国医师协会神经内科医师分会疼痛和感觉障碍专委会.中国偏头痛防治指南[J].中国疼痛医学杂志,2016,22(10):721-727.
[3]于生元.从宏观到微观认识头痛[J].中国疼痛医学杂志,2014,20(1):2-4.
[4]Guegan-Massardier E,Lucas C.Migraine and vascular risk[J].Rev Neurol,2013,169(5):397-405.
[5]Donnet A.La migraine chronique:du conceptàla prise en charge thérapeutique[J].Pratique Neurologique-FMC,2018,9(2):105-110.
[6]Karsan N,Palethorpe D,Bhola R,et al.Flunarizine in migrainerelated headache prevention:Results from 200 patients treated in the UK[J].Eur J Neurology,2018,25(6):811-817.
[7]Lai K L,Niddam D M,Fuh J L,et al.Flunarizine versus topiramate for chronic migraine prophylaxis:a randomized trial[J].Acta Neurol Scand,2017,135(4):476-483.
[8]Kim H,Byun S H,Kim J S,et al.Comparison of flunarizine and topiramate for the prophylaxis of pediatric migraines.[J].Eur JPaediatr Neurol,2013,17(1):45-49.
[9]Cekic E G,Soydan G,Guler S,et al.Propranolol-induced relaxation in the rat basilar artery.[J].Vascul Pharmacol,2013,58(4):307-312.
[10]Salviz M,Yuce T,Acar H,et al.Propranolol and venlafaxine for vestibular migraine prophylaxis:A randomized controlled trial[J].Laryngoscope,2016,126(1):169-174.
[11]Fallah R,Divanizadeh M S,Karimi M,et al.Topiramate and propranolol for prophylaxis of migraine[J].Indian J Pediatr,2013,80(11):920-924.
[12]Clark A M,Kriel R L,Leppik I E,et al.Intravenous topiramate:Safety and pharmacokinetics following a single dose in patients with epilepsy or migraines taking oral topiramate[J].Epilepsia,2013,54(6):1106-1111.
[13]Yaman M,Ucok K,Demirbas H,et al.Effects of topiramate use on body composition and resting metabolic rate in migraine patients.[J].Neurol Sci,2013,34(2):225-229.
[14]Marmura M J.Safety of topiramate for treating migraines.[J].Expert Opin Drug Saf,2014,13(9):1241-1247.
[15]Medrano-Martínez V,Pérez-Sempere A,Moltó-JordáJ M,et al.Eyelid myokymia in patients with migraine taking topiramate[J].Acta Neurol Scand,2015,132(2):143-146.
[16]Spritzer S D,Bravo T P,Drazkowski J F.Topiramate for treatment in patients with migraine and epilepsy[J].Headache,2016,56(6):1081-1085.
[17]Silberstein S D.Topiramate in migraine prevention:A 2016perspective[J].Headache,2017,57:165-178.
[18]Cao Z,Lin C T,Chuang C H,et al.Resting-state EEG power and coherence vary between migraine phases:[J].J Headache Pain,2016,17(1):102.
[19]Karcay Ozkalayci S,Nazliel B,Batur Caglayan H Z,et al.Cerebral blood flow velocity in migraine and chronic tension-type headache patients[J].J Pain Res,2018,11:661-666.
[20]Demarquay G,André-Obadia N,Caclin A,et al.Neurophysiological evaluation of cartical excitability in migraine:a review of the literature[J].Rev Neurol,2013,169(5):427-435.
[2]中华医学会疼痛学分会头面痛学组,中国医师协会神经内科医师分会疼痛和感觉障碍专委会.中国偏头痛防治指南[J].中国疼痛医学杂志,2016,22(10):721-727.
[3]于生元.从宏观到微观认识头痛[J].中国疼痛医学杂志,2014,20(1):2-4.
[4]Guegan-Massardier E,Lucas C.Migraine and vascular risk[J].Rev Neurol,2013,169(5):397-405.
[5]Donnet A.La migraine chronique:du conceptàla prise en charge thérapeutique[J].Pratique Neurologique-FMC,2018,9(2):105-110.
[6]Karsan N,Palethorpe D,Bhola R,et al.Flunarizine in migrainerelated headache prevention:Results from 200 patients treated in the UK[J].Eur J Neurology,2018,25(6):811-817.
[7]Lai K L,Niddam D M,Fuh J L,et al.Flunarizine versus topiramate for chronic migraine prophylaxis:a randomized trial[J].Acta Neurol Scand,2017,135(4):476-483.
[8]Kim H,Byun S H,Kim J S,et al.Comparison of flunarizine and topiramate for the prophylaxis of pediatric migraines.[J].Eur JPaediatr Neurol,2013,17(1):45-49.
[9]Cekic E G,Soydan G,Guler S,et al.Propranolol-induced relaxation in the rat basilar artery.[J].Vascul Pharmacol,2013,58(4):307-312.
[10]Salviz M,Yuce T,Acar H,et al.Propranolol and venlafaxine for vestibular migraine prophylaxis:A randomized controlled trial[J].Laryngoscope,2016,126(1):169-174.
[11]Fallah R,Divanizadeh M S,Karimi M,et al.Topiramate and propranolol for prophylaxis of migraine[J].Indian J Pediatr,2013,80(11):920-924.
[12]Clark A M,Kriel R L,Leppik I E,et al.Intravenous topiramate:Safety and pharmacokinetics following a single dose in patients with epilepsy or migraines taking oral topiramate[J].Epilepsia,2013,54(6):1106-1111.
[13]Yaman M,Ucok K,Demirbas H,et al.Effects of topiramate use on body composition and resting metabolic rate in migraine patients.[J].Neurol Sci,2013,34(2):225-229.
[14]Marmura M J.Safety of topiramate for treating migraines.[J].Expert Opin Drug Saf,2014,13(9):1241-1247.
[15]Medrano-Martínez V,Pérez-Sempere A,Moltó-JordáJ M,et al.Eyelid myokymia in patients with migraine taking topiramate[J].Acta Neurol Scand,2015,132(2):143-146.
[16]Spritzer S D,Bravo T P,Drazkowski J F.Topiramate for treatment in patients with migraine and epilepsy[J].Headache,2016,56(6):1081-1085.
[17]Silberstein S D.Topiramate in migraine prevention:A 2016perspective[J].Headache,2017,57:165-178.
[18]Cao Z,Lin C T,Chuang C H,et al.Resting-state EEG power and coherence vary between migraine phases:[J].J Headache Pain,2016,17(1):102.
[19]Karcay Ozkalayci S,Nazliel B,Batur Caglayan H Z,et al.Cerebral blood flow velocity in migraine and chronic tension-type headache patients[J].J Pain Res,2018,11:661-666.
[20]Demarquay G,André-Obadia N,Caclin A,et al.Neurophysiological evaluation of cartical excitability in migraine:a review of the literature[J].Rev Neurol,2013,169(5):427-435.