小儿惊厥性癫痫持续状态的临床特征及预后分析  

The clinical feature and prognosis predictors associtated with outcome for convulsive status epilepticus children

作　　者：翟琼香[1] 梁惠慈[2] 丁健[1] 张宇昕[1] 郝英[1] 

机构地区：[1]广东省人民医院儿科,广州510120 [2]广州市儿童医院神经康复科

出　　处：《中华急诊医学杂志》2009年第7期728-731,共4页Chinese Journal of Emergency Medicine

基　　金：广东省科技计划资助项目（2006836004008）;广东省自然基金资助项日（20071015）

摘　　要：目的探讨小儿惊厥性癫痫持续状态（CSE）患者的临床特征及预后的相关因素，为有效的预防和治疗小儿CSE提供依据。方法采用连续登记建立数据库的方法，前瞻性观察于1998年10月至2008年10月广东省人民医院儿科及广州市儿童医院急诊及住院的CSE患者，按1993年国际抗癫痫联盟（ILAE）的诊断标准进行诊断，用X^2检验、秩和检验及logistic分析进行预后相关因素分析。结果纳入本组169例患者，其中农村92例（54．4％）。首要病因为中枢神经系统感染71例（42．0％），其次为停或减用抗癫痫药、脑出血。农村的患儿治疗前抽搐时间较城市的患儿抽搐时间长（P〈0．01），接受治疗前持续时间与预后有关（P〈0．01），总持续时间与预后有关（P〈0．01），死亡率为14．2％。Logistic回归分析示，来源地、治疗前持续时间、呼吸抑制为影响预后的独立因素（P〈0．05）。结论农村的患儿是CSE主要人群，中枢神经系统感染是首要的病因。CSE总时间及治疗前CSE时间是影响死亡率及致残率的一个重要因素。Objective To investigate the clinical manifestation of convulsive status epilepticus （CSE） associated with the outcome of children contracted this illness in order to make an effort to prevent and treat those children. Method The patients with CSE admitted from October 1998 to October 2008 were prospectively and consecutively enrolled. All the patients met the diagnostic criteria set by International Anti-epilepsy Union （ILAE） in 1993. The prognosis predictors of outcome were analyzed with the Rank sum test, Chi-square analysis and Logistic regression analysis. Results A total of 169 patients with CSE were enrolled. Of them, 92 patients were from rural areas （54.4%）. The primary cause was central nervous system infection, and the minor ones were a reduction of dose or withdrawal of the antiepileptics, and cerebral hemorrhage. The duration of CSE before treatment was longer in rural patients than in urban residents （P 〈 0.01 ）. The duration of CSE before treatment and the total persistence time of CSE was significantly associated with the mortality 14.2%. The source of patients, the duration before treatment, arid respiratory depression were independent prognostic predictor variables of CSE （ P 〈 0. 05）. Conclusions The rural patients account for the major ratio of convulsive status epilepticus. Central nervous system infection is the primary cause. The duration before treatment and total persistence time of CSE are highly related to the mortality and morbidity.

关 键 词：小儿 惊厥 惊厥性癫痫持续状态 预后 

分 类 号：R742[医药卫生—神经病学与精神病学]