颅脑损伤后行早期颅骨修补术与癫痫发作的相关性  

Correlation analysis of seizures after early cranioplasty for craniocerebral injury

作　　者：岑庆君[1] 赵昆玉 黎海滨[1] 高忠恩[1] 冯荣亮[1] 张鹏[1] 严志东[1] CEN Qing-jun;ZHAO Kun-yu;LI Hai-bin;GAO Zhong-en;FENG Rong-liang;ZHANG Peng;YAN Zhi-dong(Department of Neurosurgery,The First People's Hospital of Zhaoqing,Zhaoqing 526060,Guangdong,China)

机构地区：[1]肇庆市第一人民医院神经外科,广东肇庆526000

出　　处：《广东医学》2020年第14期1485-1488,共4页Guangdong Medical Journal

摘　　要：目的分析颅脑损伤去骨瓣减压后早期行颅骨修补患者术后癫痫发作相关危险因素,并对围手术期进行预防性抗癫痫治疗进行探讨。方法对108例早期颅骨修补术后并发癫痫发作的31例患者进行回顾性分析,总结术后癫痫发作的危险因素;对围手术期的预防用药进行探讨。结果损伤部位、颅骨缺损面积、术前缺损部位软化灶、颅骨凹陷性骨折、术后钛网板下积液和(或)积血、预防性使用抗癫痫药物与早期颅骨修补术后癫痫发生密切相关,其中损伤部位、颅骨缺损面积、颅骨骨折、术后钛网板下积液和(或)积血是术后癫痫发生的危险因素(P<0.05),而预防性使用抗癫痫药物为保护因素(P<0.05)。结论颅骨修补术后癫痫的发病率较高,脑损伤去骨瓣减压时避免过度开窗,预防性使用抗癫痫药物、防止术后钛网板下积液和(或)积血有助于降低颅骨缺损修补术后癫痫的发生,合并有骨折及额颞叶脑挫伤患者更应积极预防癫痫。Objective To analyze the risk factors of seizures after early cranioplasty for decompressive craniectomy in craniocerebral injury,and to discuss preventive antiepileptic treatment during perioperative period.Methods A retrospective analysis was performed on 108 patients with early cranioplasty from 2014 to 2018.Thirty-one patients were with seizures.We summarized the risk factors of postoperative seizures.The perioperative preventive medication was also discussed.Results Injury site,skull defect area,preoperative defect site softening focus,depressed fracture of the skull,the effusion/hematoma under titanium mesh and preventive antiepileptic treatment were closely correlated with seizures after early cranioplasty.Injury site,skull defect area,depressed fracture of the skull,the effusion/hematoma under titanium mesh were risk factors for postoperative epilepsy(P<0.05),and preventive antiepileptic treatment was the protective factor(P<0.05).Conclusion The incidence of epilepsy after skull repair is high.It is necessary to avoid large bone window when decompressing for craniocerebral injury.Preventive antiepileptic treatment and prevention of effusion/hematoma under titanium mesh can also reduce the incidence of epilepsy after cranioplasty,and patients with fractures and frontotemporal brain contusions requires active prevention of epilepsy.

关 键 词：颅脑损伤 去骨瓣减压术 早期颅骨修补术 癫痫 

分 类 号：R651.11[医药卫生—外科学] R742.1[医药卫生—临床医学]