抗癫痫药物对新生儿惊厥有不同的作用,近年来,新型药剂得到了广泛的应用。同时,新生儿惊厥的治疗仍然存在显著差异,无论是选择药物还是治疗期间。随着治疗选择的增加,尚未推荐二线治疗的最佳选择。
MEDLINE,Cochrane图书馆,WebofScience,检索了Embase和clinicaltrials.gov数据库(1960年1月1日至2020年10月20日)。选择研究抗癫痫药物治疗新生儿癫痫的随机对照试验(RCT)或观察性研究。然后,我们进行了网络荟萃分析,并检查了一线和二线抗癫痫药物对新生儿癫痫发作的比较疗效。
数据来自2名独立研究者的11项纳入研究。随机效应模型用于估计比值比(OR)。我们对一线和二线药物进行了随机效应模型和网络荟萃分析的直接荟萃分析。5个已发表的RCT和6个观察性调查,1333名患者和6个干预措施为分析做出了贡献。
我们推荐苯巴比妥作为治疗新生儿惊厥的一线药物。此外,对于一线药物失效后的新生儿惊厥,左乙拉西坦有成为有效二线治疗的趋势.
Anti-epileptic drugs have different effects on neonatal seizures, and new agents have been widely used in recent years. Meanwhile, significant differences still exist in the treatment for neonatal seizures, whether in choice of drug or in duration of treatment. And with the increase in options for treatment, the best choice of second-line treatment has not been recommended.
The MEDLINE, the Cochrane Library, Web of Science, Embase and clinicaltrials.gov databases were searched (January 1, 1960 to October 20, 2020). Randomized controlled trials (RCTs) or observational investigations studying anti-epileptic drugs for neonatal seizures were selected. And then we conducted a network meta-analysis and examined comparative efficacy of the first-line and second-line anti-epileptic drugs for neonatal seizures.
Data were extracted from 11 included studies by 2 independent investigators. Random effects models were used to estimate odds ratios (ORs). We performed direct meta-analyses with a random effects model and network meta-analyses for first-line and second-line drugs. Five published RCTs and 6 observational investigations with 1333 patients and 6 interventions contributed to the analysis.
We recommend phenobarbital as the first-line drug for neonatal seizures. In addition, there is a tendency for levetiracetam to be an effective second-line treatment for neonatal seizures after failure of first-line drugs.