本文選題：癲癇　切入點(diǎn)：發(fā)作期　出處：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的通過(guò)視頻腦電圖監(jiān)測(cè)VEEG(video electroencephalography)及同步心電圖ECG(electrocardiogram)描記對(duì)癲癇發(fā)作期及發(fā)作間期的患者進(jìn)行腦電及心電分析,觀察腦電圖的異常放電以及不同的癲癇發(fā)作類型是否會(huì)影響到心電活動(dòng),導(dǎo)致心律失常,從而引起惡性心律失常,進(jìn)而導(dǎo)致癲癇猝死SUDEP(Sudden Unexpected Death in Epilepsy)的發(fā)生。資料與方法收集2013年1月-2016年12月就診于天津醫(yī)科大學(xué)總醫(yī)院神經(jīng)內(nèi)科門診的已確診為癲癇病的患者649例,均進(jìn)行長(zhǎng)程視頻腦電圖+同步心電監(jiān)測(cè)(8~24h)。其中發(fā)作期患者453例(簡(jiǎn)單部分性發(fā)作患者187例,復(fù)雜部分性發(fā)作患者182例,全面強(qiáng)直陣攣性發(fā)作患者84例);發(fā)作間期患者196例,其中有異常放電者157例,無(wú)異常放電者39例。觀察所有患者的腦電及同步心電變化,對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,并分組研究癲癇發(fā)作期不同發(fā)作類型與心律失常的相關(guān)性及發(fā)作間期腦部的異常放電與心律失常的相關(guān)性。結(jié)果癲癇患者發(fā)作間期視頻腦電圖監(jiān)測(cè)到有異常放電組157例中,心電圖出現(xiàn)竇性心動(dòng)過(guò)速者40例,出現(xiàn)心動(dòng)過(guò)緩者72例,出現(xiàn)房性早搏者32例。無(wú)異常放電組39例,心電圖出現(xiàn)竇性心動(dòng)過(guò)速者8例,出現(xiàn)竇性心動(dòng)過(guò)緩者16例,出現(xiàn)房性早搏者6例。癲癇發(fā)作間期有異常放電組與無(wú)異常放電組心律異常的發(fā)生率比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。腦電圖是否有異常放電與心電圖是否有改變沒(méi)有相關(guān)性(R2=0.007,P=0.238)。癲癇患者發(fā)作期,簡(jiǎn)單部分性發(fā)作,心電圖出現(xiàn)竇性心律失常者87例,房性及室上性心律失常者42例,QT間期延長(zhǎng)及室性心律失常者4例。復(fù)雜部分性發(fā)作,心電圖出現(xiàn)竇性心律失常者78例,房性及室上性心律失常者43例,QT間期延長(zhǎng)及室性心律失常者23例。全面強(qiáng)直陣攣性發(fā)作,心電圖出現(xiàn)竇性心律失常者33例,房性及室上性心律失常者19例,QT間期延長(zhǎng)及室性心律失常者15例。僅有發(fā)作間期放電組和簡(jiǎn)單部分性發(fā)作組的組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),復(fù)雜部分性發(fā)作組和全面強(qiáng)直陣攣性發(fā)作組的組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),復(fù)雜部分性發(fā)作組和全面強(qiáng)直陣攣性發(fā)作組分別與發(fā)作間期組或簡(jiǎn)單部分性發(fā)作組的組間比較差異均有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論癲癇發(fā)作期患者不同發(fā)作類型出現(xiàn)心律失常的情況不同:1.簡(jiǎn)單部分性發(fā)作患者對(duì)心律影響較小,可不出現(xiàn)或只出現(xiàn)竇性或房性心律失常;2.復(fù)雜部分性發(fā)作及全面強(qiáng)直陣攣性發(fā)作患者對(duì)心律影響較明顯,可出現(xiàn)竇性、房性、室上性甚至室性心律失常。已經(jīng)確診為癲癇的患者無(wú)論癲癇是否完全控制,在癲癇發(fā)作間期:1.無(wú)論腦電圖是否有異常放電,患者均無(wú)可導(dǎo)致癲癇猝死的惡性心律失常發(fā)生;2.癲癇發(fā)作間期的腦部異常放電,與引起心電活動(dòng)異常,從而導(dǎo)致心律失常沒(méi)有相關(guān)性。
[Abstract]:Objective to analyze the electroencephalogram (EEG) and electrocardiograms (ECG) of VEEG(video in patients with epilepsy and interictal period by video electroencephalography (EEG) monitoring, and to analyze the electroencephalogram (EEG) and electrocardiogram (ECG) of the patients in the interictal period.To observe whether abnormal EEG discharges and different epileptic seizure types will affect ECG activity, lead to arrhythmia, lead to malignant arrhythmia, and lead to sudden death of SUDEP(Sudden Unexpected Death in Epilepsys.Materials and methods from January 2013 to December 2016, 649 patients with epilepsy were enrolled in the Department of Neurology, General Hospital of Tianjin Medical University.Among them, 453 cases (187 cases of simple partial seizure, 182 cases of complex partial seizure, 84 cases of comprehensive tonic-clonic seizure), 196 cases of interictal phase, 157 cases of abnormal discharge, 39 cases of no abnormal discharge.The changes of EEG and synchronous ECG in all patients were observed and the data were analyzed statistically. The correlation between different types of seizures and arrhythmias and the relationship between abnormal discharges in the brain and arrhythmias in the interictal period were studied.Results in 157 patients with abnormal discharge, 40 patients had sinus tachycardia, 72 patients had bradycardia and 32 patients had atrial premature beats.In no abnormal discharge group, there were 8 cases of sinus tachycardia, 16 cases of sinus bradycardia and 6 cases of atrial premature beats.There was no significant difference in the incidence of arrhythmia between the patients with abnormal discharges and those without abnormal discharges during interictal seizures (P 0.05).There was no correlation between abnormal electroencephalogram (EEG) and electrocardiogram (ECG).There were 87 cases of sinus arrhythmia in electrocardiogram, 42 cases of atrial and supraventricular arrhythmia, 4 cases of prolonged QT interval and ventricular arrhythmia.There were 78 cases of sinus arrhythmia in electrocardiogram, 43 cases of atrial and supraventricular arrhythmias, 23 cases of prolonged QT interval and ventricular arrhythmia.There were 33 cases of sinus arrhythmia in ECG, 19 cases of atrial and supraventricular arrhythmias, 15 cases of prolonged QT interval and ventricular arrhythmia.There was no significant difference between the interictal discharge group and the simple partial seizure group, but there was no significant difference between the complex partial seizure group and the total tonic-clonic seizure group.There were significant differences between the seizure group and the total tonic-clonic seizure group and the interictal group or the simple partial seizure group (P 0.001).Conclusion the incidence of arrhythmia in patients with epileptic seizures varies from one to one.Simple partial attack patients have little effect on cardiac rhythm, can not appear or only sinus or atrial arrhythmia 2.Complex partial seizures and generalized tonic-clonic seizures have obvious effects on arrhythmias, including sinus, atrial, supraventricular and even ventricular arrhythmias.People who have been diagnosed with epilepsy, whether or not they have complete control of epilepsy, are at: 1. 1 during the interictal period.No matter whether EEG is abnormal or not, there is no malignant arrhythmia caused by sudden Epilepsy death.Abnormal discharges in the brain during interictal seizures have no correlation with abnormal electrocardiogram, which leads to arrhythmias.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R742.1

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本文編號(hào)：1717148