儿童重症监护病房284例脑电图监测儿童癫痫发作的危险因素及其与预后的相关性  

Risk factors and correlation with prognosis of epileptic seizures in 284 pediatric patients in pediatric intensive care unit with electroencephalography monitoring

作　　者：管巧 刘刚[1] 桑田[2] 刘珺[1] 姜玉武[2] 钱素云[1] Guan Qiao;Liu Gang;Sang Tian;Liu Jun;Jiang Yuwu;Qian Suyun(Department of Pediatric Intensive Care Unit,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Department of Pediatrics,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院重症医学科,北京100045 [2]北京大学第一医院儿科,北京100034

出　　处：《中华实用儿科临床杂志》2023年第9期702-706,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：北京市重大疫情防治重点专科卓越项目。

摘　　要：目的了解儿童重症监护病房(PICU)脑损伤患儿癫痫发作情况,明确癫痫发作相关危险因素并探讨癫痫发作与预后的关系。方法回顾性收集2013年1月至2019年12月收治于北京大学第一医院PICU,存在脑损伤且行床旁视频脑电图(VEEG)监测的患儿资料,包括一般人口学信息、病因、VEEG监测前有无惊厥发作、住院病死率、脑功能评分、VEEG特征等。以VEEG监测到的癫痫发作为主要观察指标,以出PICU时预后情况为次要观察指标。采用Logistic回归分析癫痫发作和不良预后的相关因素。结果共纳入284例患儿,其中男性占54.9%(156/284),中位年龄1.7(0.5,5.0)岁;病因中45.1%(128/284)的患儿既往诊断癫痫、26.1%(74/128)存在遗传代谢病、14.4%(41/284)存在中枢神经系统感染等。VEEG监测到82.0%(233/284)的患儿存在背景活动异常,59.5%(169/284)存在间期放电,37.3%(106/284)存在癫痫发作,其中非惊厥性发作和非惊厥性癫痫持续状态发生率为39.6%(42/106)和24.5%(26/106)。12.0%(34/284)的患儿出院时预后不良,包括24例住院死亡,10例存活者脑功能分类量表评分增加。多因素Logistic回归分析显示,VEEG监测前惊厥发作、VEEG提示有发作间期放电是癫痫发作的独立危险因素;智力发育迟滞、脓毒症相关脑病、VEEG监测时有意识障碍、VEEG背景活动异常、有癫痫持续状态与不良预后相关。结论PICU脑损伤患儿癫痫发作发生率较高。积极开展脑损伤患儿VEEG监测,有助于早期识别癫痫发作,并对其预后做出预测。Objective To illustrate the onset of epileptic seizures in children with brain injury admitted in pediatric intensive care unit(PICU),and to explore the risk factors and the correlation between epileptic seizures and the prognosis.Methods Clinical data of pediatric patients with brain injury who were admitted to PICU of Peking University First Hospital from January 2013 to December 2019,and monitored by video electroencephalography(VEEG)were retrospectively collected,including general demographic information,etiological data,clinical seizures prior to VEEG performing,in-hospital mortality,brain function score,VEEG manifestations,etc.Seizures detected by VEEG were the primary outcome,and prognosis when discharged from PICU was the secondary outcome.Logistic regression was used to analyze the factors associated with seizures and poor outcome.Results A total of 284 children were included,involving 54.9%(156/284)males.The median age of included children was 1.7(0.5,5.0)years.Stratified by the cause of disease,45.1%(128/284)had epilepsy,26.1%(74/128)had genetic metabolic disease,and 14.4%(41/284)had central nervous system infection.A total of 82.0%(233/284)children had abnormal VEEG background activities,and 59.5%(169/284)had interictal epileptic discharges.Seizures were detected in 106 cases,including 39.6%(42/106)of non-convulsive seizures and 24.5%(26/106)of non-convulsive epileptic states.There were 12.0%(34/284)had poor prognosis at discharge,including 24 patients died in-hospital,and Pediatric Cerebral Performance Category scores were increased in 10 survivors.Multivariate Logistic regression analysis showed that seizures existed before VEEG monitoring and interictal epileptiform discharge were the independent risk factors for seizure.Besides,mental retardation,sepsis related encephalopathy,consciousness abnormality during VEEG,abnormal VEEG background activity,and epileptic status were significantly correlated with the poor prognosis of children with brain injury in PICU.Conclusions The incidence of electrograp

关 键 词：癫痫发作 脑电图 预后 儿科重症监护病房 

分 类 号：R742.1[医药卫生—神经病学与精神病学]