高原地区重型颅脑损伤患者早期癫痫发作的影响因素  

Influential factors of early epileptic seizures in patients with severe head injury in plateau area

作　　者：王齐 卢成康 张伟 陈颖 李治宏 李亮 WANG Qi;LU Chengkang;ZHANG Wei;CHEN Ying;LI Zhihong;LI Liang(Department of Critical Care Medicine,Ganzi Tibetan Autonomous Prefecture People′s Hospital,Ganzi 626000,Sichuan,China;Department of Neurosurgery,Ganzi Tibetan Autonomous Prefecture People′s Hospital,Ganzi 626000,Sichuan,China;The First Department of Hepatobiliary,Ganzi Tibetan Autonomous Prefecture People′s Hospital,Ganzi 626000,Sichuan,China;Department of Emergency Medicine,Eastern Theater Command General Hospital,Nanjing 210002,China)

机构地区：[1]甘孜州藏族自治州人民医院重症医学科,甘孜康定626000 [2]甘孜州藏族自治州人民医院神经外科,甘孜康定626000 [3]甘孜州藏族自治州人民医院肝胆一科,甘孜康定626000 [4]东部战区总医院急诊医学科,江苏南京210002

出　　处：《西部医学》2022年第6期847-850,共4页Medical Journal of West China

基　　金：国家重点研发计划“精准医学研究”专项课题(2017YFC0909903)。

摘　　要：目的探讨高原地区重型颅脑损伤患者早期癫痫发作的影响因素。方法回顾性分析2016年3月~2021年3月在甘孜州藏族自治州人民医院接受诊治的500例重型颅脑损伤患者的临床资料,按照患者是否存在早期癫痫发作分为观察组(患者早期癫痫发作,n=50)和对照组(患者未存在早期癫痫发作,n=450)。采用单因素和多因素Logistic回归分析高原地区重型颅脑损伤患者早期癫痫发作的影响因素。结果单因素分析结果显示,不同年龄、不同性别、不同颅骨骨折、不同电解质情况、不同高血压病史、不同糖尿病史、不同癫痫家族史重型颅脑损伤患者的早期癫痫发生情况差异无统计学意义(P>0.05)。中线移位、并发脑积水、颅内血肿、并发脑挫裂伤、硬脑膜破裂可能是影响重型颅脑损伤患者早期癫痫发作的相关因素(P<0.05)。将单因素分析中P<0.05的指标纳入多因素Logistic回归模型,进行多元线性回归分析显示,脑挫裂伤、中线移位是影响重型颅脑损伤患者早期癫痫发作的独立危险因素(P<0.05)。结论脑挫裂伤、中线移位是影响高原地区重型颅脑损伤患者早期癫痫发作的独立危险因素,在临床中应密切关注。Objective To explore the influencing factors of early epileptic seizures in patients with severe head injury in plateau area.Methods The clinical data of 500 patients with severe head injury who were diagnosed and treated in Ganzi Tibetan Autonomous Prefecture People′s Hospital,from March 2016 to March 2021 were retrospectively analyzed.According to whether the patients had early seizures,they were divided into observation group(patients with early seizures,n=50),control group(patients did not have early seizures,n=450).Single factor and multivariate Logistic regression were used to analyze the influencing factors of early epileptic seizures in patients with severe head injury at high altitude.Results The results of univariate analysis showed that the results of univariate analysis showed the occurrence of early epilepsy in patients with severe head injury of different ages,different genders,different skull fractures,different electrolytes,different history of hypertension,different diabetes history,and different family history of epilepsy The difference was not statistically significant(P>0.05).Midline shift,complicated hydrocephalus,intracranial hematoma,complicated brain contusion and laceration,and rupture of the dura may be related factors affecting early epileptic seizures in patients with severe head injury(P<0.05).The index of the univariate analysis was incorporated into the multivariate logistic regression model,and the multiple linear regression analysis was performed.The results showed that brain contusion and laceration and midline displacement are independent risk factors that affect early-onset seizures in patients with severe head injury(P<0.05).Conclusion Cerebral contusion and laceration and midline displacement are independent risk factors that affect early epileptic seizures in patients with severe head injury at high altitude,and should be closely monitored in clinical practice.

关 键 词：重型颅脑损伤 高原地区 癫痫发作 早期 脑挫裂伤 中线移位 

分 类 号：R651.15[医药卫生—外科学]