高血压性脑出血患者行立体定向血肿抽吸术后癫痫发生情况及影响因素  

Analysis of Occurrence and Influencing Factors of Epilepsy in Hypertensive Intracerebral Hemorrhage Patients after Stereotactic Hematoma Aspiration

作　　者：赵冠焱[1] 宁理懂 蓝欢[1] 谢昌纪[1] 韦成聪[1] 李光[1] 周志宇[1] ZHAO Guanyan;NING Lidong;LAN Huan;XIE Changji;WEI Chengcong;LI Guang;ZHOU Zhiyu(Department of Neurosurgery,Guangxi Zhuang Autonomous Region Ethnic Hospital,Nanning 530001,China)

机构地区：[1]广西壮族自治区民族医院神经外科,南宁530001

出　　处：《医学综述》2023年第11期2284-2288,共5页Medical Recapitulate

摘　　要：目的分析高血压性脑出血(HICH)患者行立体定向血肿抽吸术后癫痫发生情况及其影响因素。方法回顾性分析2020年2月至2021年9月在广西壮族自治区民族医院神经外科行立体定向血肿抽吸术的156例HICH患者的临床资料。根据术后是否发生癫痫分为癫痫组和无癫痫组。采用Logistic回归分析HICH患者行立体定向血肿抽吸术后癫痫发生的影响因素。结果156例行立体定向血肿抽吸术HICH患者中,30例发生癫痫,发生率为19.23%,其中部分发作18例、癫痫持续状态4例、全身强直阵挛性发作8例;25例于术后24 h内癫痫发作,3例于术后24 h至2周癫痫发作,2例于术后2周后癫痫发作。两组性别、吸烟、饮酒、体质量指数、发病至手术时间、术前格拉斯哥昏迷评分、血钠浓度、糖尿病史占比比较差异无统计学意义(P>0.05)。两组患者年龄、血肿位置、血肿体积分布比较差异有统计学意义(P<0.05或P<0.01),癫痫组脑电图异常、电解质异常、术后再出血、脑积水、有致痫药物史占比以及血清CRP水平均高于无癫痫组[66.67%(20/30)比24.6%(31/126)、83.33%(25/30)比53.97%(68/126)、46.67%(14/30)比15.87%(20/126)、73.33%(22/30)比44.44%(56/126)、73.33%(22/30)比41.27%(52/126)、(14.25±4.61)g/L比(8.75±3.37)g/L](P<0.01)。将单因素分析中有统计学意义的因素采用逐步向前法进行Logistic回归分析,结果显示,脑电图异常、电解质异常、血肿位于小脑、血肿体积≥60 ml、术后再出血、CRP水平升高均是HICH患者术后癫痫发生的独立影响因素(OR=2.344,95%CI 1.531~3.158;OR=1.984,95%CI 1.074~2.894;OR=1.754,95%CI 0.572~2.936;OR=1.958,95%CI 0.962~2.954;OR=1.946,95%CI 0.639~3.254;OR=2.512,95%CI 1.444~3.580)(均P<0.01)。结论HICH患者行立体定向血肿抽吸术后癫痫的发生率较高,脑电图异常、电解质异常、血肿位于小脑、血肿体积≥60 ml、术后再出血、血清CRP水平升高是HICH患者发生术后癫痫的危险因Objective To analyze the occurrence and influencing factors of epilepsy in hypertensive intracerebral hemorrhage(HICH)patients after stereotactic hematoma aspiration.Methods The clinical data of 156 patients with HICH who underwent stereotactic hematoma aspiration in the Department of Neurosurgery in Guangxi Zhuang Autonomous Region Ethnic Hospital from Feb.2020 to Sep.2021 were retrospectively analyzed.The cases were divided into an epilepsy group and a non-epileptic group according to whether epilepsy occurred after the operation.Logistic regression was used to analyze the influencing factors of epilepsy after stereotactic hematoma aspiration in HICH patients.Results Among the 156 HICH patients,30 cases had epilepsy(19.23%),including 18 cases of partial seizures,4 cases of persistent epilepsy and 8 cases of general tonic-clonic seizures;25 cases had seizures within 24 h after surgery,3 cases had seizures 24 h to 2 weeks after surgery,and 2 cases had seizures 2 weeks after surgery.There were no significant differences in gender,smoking,alcohol consumption,body mass index,time from onset to operation,preoperative Glasgow comd score,blood sodium concentration and diabetes history between the two groups(P>0.05).There were significant differences in age,hematoma location and hematoma volume distribution between the two groups(P<0.05 or P<0.01).The proportions of abnormal electroencephalogram(EEG),abnormal electrolyte,postoperative rebleeding,hydrocephalus,history of epileptogenic drugs and serum CRP levels in the epileptic group were higher than those in the non-epileptic group[66.67%(20/30)vs 24.6%(31/126),83.33%(25/30)vs 53.97%(68/126),46.67%(14/30)vs 15.87%(20/126),73.33%(22/30)vs 44.44%(56/126),73.33%(22/30)vs 41.27%(52/126),(14.25±4.61)g/L vs(8.75±3.37)g/L](P<0.01).Statistically significant factors from univariate analysis were included in the stepwise forward Logistic regression analysis,and the results showed that abnormal EEG,abnormal electrolyte,hematoma located in cerebellum,hematoma volume≥60 ml,posto

关 键 词：高血压性脑出血 立体定向 血肿抽吸术 癫痫 影响因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]