难治惊厥性癫痫持续状态53例病死率及特征  

Analysis of themortality and clinical features of refractory convulsive status epilepticus

作　　者：李银萍[1] 涂良丹[1] 李劲梅[1] 李艳[1] 杨蓉[1] LI Yingping;TU Liangdan;LI Jinmei;LI Yan;YANG Rong(Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China)

机构地区：[1]四川大学华西医院神经内科,四川成都610041

出　　处：《西部医学》2021年第6期846-849,855,共5页Medical Journal of West China

基　　金：国家自然科学基金面上项目(81571272);四川省科技厅应用基础研究计划项目(2019YFH0145);四川大学华西护理学院院内重点项目(HXHL20004)。

摘　　要：目的分析难治惊厥性癫痫持续状态(Status Epilepticus,SE)的病死率及其影响因素,为提高难治惊厥性癫痫患者生存率提供科学依据。方法对2015年1月~2019年12月连续登记住院治疗的53例难治性惊厥性癫痫持续状态患者,统计分析人口学资料、临床特征、死亡率、病因,治疗等。结果53例患者中21例死亡,病死率39.6%。死亡者年龄均数(34.5±16.2)岁;死亡患者SE持续时间长于存活患者(P<0.001),死亡前三位病因是:颅内感染(33.3%),脑外伤(19%),中毒(14.3%)。癫痫持续状态持续时间、影像学发现相关性病灶、多器官衰竭、机械通气是死亡的独立危险因素。死亡患者对二线抗癫痫药物联合治疗反应差。结论难治惊厥性癫痫持续状态死亡率高,需重视其影响因素,为难治惊厥性癫痫持续状态早期正确的诊治提供参考,以提高患者生存率及改善其预后。Objective To study the fatality rate of refractory convulsive status epilepticus and its risk factors,as well as analyze the clinical features,so as to provide clinical evidence for the improvement of refractory convulsive status epilepticus treatment.Methods From January 2015 to December 2019,a continuous recording of Status Epilepticus(SE)patients was done and 53 refractory convulsive status epilepticus(CSE)patients was included in our research.The demographics,clinical features,fatality rate,pathogenesis and treatment were analyzed.Results Among the 53 included cases,21 patients resulted in death(fatality rate 39.6%).Mean age at death was 34.5±16.2.Duration of SE of the deaths was significantly longer than the survivors(P<0.01).The top three cause of fatal SE were intracranial infection(33.3%),brain trauma(19%),and intoxication(14.3%).Duration of SE,related lesion found in radiology,multiple organ failure,Mechanical and ventilation were independent risk factors of SE.All patients poorly respond to second-line anti-epileptic drugs.Conclusion Refractory CSE in southwest China was region-specific.Death mainly occurred in young and middle-aged.Intracranial infection,brain trauma and intoxication were main death.Independent risk factors included Duration of SE,lesion on MRI related to RCSE,multiple organs failure(MOF),and Mechanical ventilation.Death cases poorly response to second-line anti-epileptic drugs.Drawing attention on these factors may improve early diagnosis of refractory CSE,survivability and prognosis.

关 键 词：惊厥性癫痫 癫痫持续状态 死亡率 影响因素 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]