急性腦血管病繼發(fā)早期癇性發(fā)作臨床探究
發(fā)布時間：2018-09-13 09:42
【摘要】：目的： 腦血管疾病發(fā)病后，患者會遺留嚴(yán)重的肢體功能障礙，并且部分患者還會發(fā)生繼發(fā)癲癇，給患者造成嚴(yán)重的身心損害和經(jīng)濟(jì)負(fù)擔(dān)。急性腦血管病早期癇性發(fā)作后，再次發(fā)作而被確診的癲癇機(jī)率顯著提升。因此，對該病發(fā)生、發(fā)展、轉(zhuǎn)歸進(jìn)行研究意義重大。本研究旨在對急性腦血管病早期癇性發(fā)作患者的臨床資料進(jìn)行回顧性分析，以便深入了解該病的發(fā)作機(jī)制及特點(diǎn)，即患者的發(fā)病性別情況、發(fā)病年齡、發(fā)病時間、發(fā)作類型、發(fā)病部位、血腫體積與癇性發(fā)作的關(guān)系、EEG檢查和TCD檢查結(jié)果、以及治療及預(yù)后情況等。 方法： 回顧性分析2012年12月~2014年1月收集的神經(jīng)內(nèi)科住院患者資料2348例，以及其中的56例早期癇性發(fā)作患者。對所有所選患者病變的性質(zhì)、部位，患者年齡和性別，與癇性發(fā)作時間和類型，腦電圖和TCD檢測結(jié)果，以及患者治療方案及治療結(jié)果進(jìn)行統(tǒng)計(jì)研究。 結(jié)果： 1．本次共研究急性腦血管病患者2348例，其中，男1341例(占57%)，女1007例(占43%)。腦梗死2066例(占88%)，腦出血235例(占10%)，蛛網(wǎng)膜下腔出血47例(占2%)。癇性發(fā)作患者56例，其中男26例(占46%)，女30例(占54%)。患者性別對比無顯著統(tǒng)計(jì)學(xué)意義（P0.05）。其中，腦梗死后繼發(fā)發(fā)作26例(占46%)，腦出血后發(fā)作25例(占45%)，蛛網(wǎng)膜下腔出血后發(fā)作5例(占9%)。本組早期癇性發(fā)作的發(fā)生率為2%。不同的腦血管病早期癇性發(fā)作發(fā)生率占腦梗死1%，腦出血10%，蛛網(wǎng)膜下腔出血12%。結(jié)果顯示，蛛網(wǎng)膜下腔出血發(fā)病率男性略低于女性，而蛛網(wǎng)膜下腔出血癇性發(fā)作患者男性則顯著高于女性，對比有顯著統(tǒng)計(jì)學(xué)意義（P0.05）。 2．在腦梗死病人中，年齡在50歲及50歲以下的早期癇性發(fā)作發(fā)生率為0.4%，50歲的該病發(fā)生率則為1.4%，約為前者的3倍，而經(jīng)統(tǒng)計(jì)學(xué)處理后兩者對比無統(tǒng)計(jì)學(xué)意義（P0.05）。此外，腦出血和蛛網(wǎng)膜下腔出血患者50歲患者數(shù)亦較≤50歲的患者多，但經(jīng)統(tǒng)計(jì)學(xué)處理，差異亦無顯著意義（P0.05）。這表明，腦血管病的發(fā)病率隨人口年齡的增長而大量增加，造成早期癇性發(fā)作的患者比例亦隨著年齡的增長而增多。 3．發(fā)病時間：腦血管病發(fā)病同時出現(xiàn)癇性發(fā)作有5例，發(fā)病l周內(nèi)出現(xiàn)發(fā)作的有29例，l周~2周發(fā)作的有22例。 4．發(fā)作類型：部分性發(fā)作患者數(shù)量最多，為55例(約占98.2%)，其中單純部分性發(fā)作28例(50.0%)，復(fù)雜部分性發(fā)作16例(28.6%)，部分性繼發(fā)全身性發(fā)作11例(約占19.6%)，，全面性發(fā)作僅l例(約占1.8%)。 5．發(fā)病部位：腦梗死后早期癇性發(fā)作，皮質(zhì)梗死18例，占69%(18／26)，皮質(zhì)下梗死占為31%(8／26)，兩者對比差異有顯著統(tǒng)計(jì)學(xué)意義(P0.01)。腦出血后早期癇性發(fā)作25例患者中，皮質(zhì)19例，約占76%(19／25)，皮質(zhì)下6例，占24%(13／49)，兩者對比差異有統(tǒng)計(jì)學(xué)意義(P0.01)�？傊缙诎B性發(fā)作皮質(zhì)病變占64%，皮質(zhì)下病變占36%，經(jīng)統(tǒng)計(jì)學(xué)處理對比有顯著統(tǒng)計(jì)學(xué)意義。 6．血腫體積與癇性發(fā)作的關(guān)系：腦出血早期癇性發(fā)作患者出血量大于35ml的占20%(5／25)，出血量小于35ml的占9.5%(20／210)，兩者比較差異有顯著性(P0.05)。 7．EEG檢查：有31例患者進(jìn)行腦電圖檢查，結(jié)果11例異常，占36%，其中，3例為廣泛輕度異常改變（占27%），5例腦電圖為中度異常伴局限性改變（占46%），3例為重度異常（占27%）。而在中度異常及重度異常腦電圖中，5例可見到局限性的散發(fā)的尖波、棘波、尖慢復(fù)合波、棘慢復(fù)合波或爆發(fā)性的高波幅慢波節(jié)律，占43%，其他則均為用藥所致的低波幅快波節(jié)律占66%。 8．TCD檢查：TCD檢查共21例，均為腦梗死患者，被檢血管血流速度異常率為63%(92／147)，對照組40例普通腦梗死患者異常率為32%(89／280)，兩組對比有統(tǒng)計(jì)學(xué)意義(P0.01)。 9.治療及預(yù)后：未規(guī)律口服抗癲癇藥者45例，其中40例發(fā)作1次，5例發(fā)作2次，臨時靜推安定，未再次發(fā)作。其余11例接受抗癲癇藥物治療，其中服用卡馬西平6例(55%)，苯妥英鈉2例(18%)，丙戊酸鈉2例(18%)，卡馬西平聯(lián)合魯米那治療的患者1例(9%)。10例接受單一常規(guī)劑量治療有效，1例進(jìn)展為癲癇持續(xù)狀態(tài)。 結(jié)論： 1.急性腦血管病早期癇性發(fā)作發(fā)生率為2%，其中，蛛網(wǎng)膜下腔出血早期癇性發(fā)作發(fā)生率最高為11%，腦出血發(fā)生率為10%，而腦梗死發(fā)生率最少，僅為1%。另外，在蛛網(wǎng)膜下腔出血發(fā)病率中，女性高于男性，而蛛網(wǎng)膜下腔出血癇性發(fā)作則男性多于女性[44]。 2.早期癇性發(fā)作發(fā)生率和急性腦血管病發(fā)病率有一定關(guān)系，即當(dāng)急性腦血管病發(fā)病時，癇性發(fā)作的發(fā)生率會快速提升，且約在l~2周時趨于穩(wěn)定[45]。 3.早期癇性發(fā)作的發(fā)作類型較多，并且以部分性發(fā)作為主要發(fā)作類型，全面性發(fā)作最低[46]。而腦部病變部位以皮質(zhì)發(fā)生發(fā)作最高，皮質(zhì)下最低。病灶大小和癇性發(fā)作的發(fā)生率有一定關(guān)系。 4.TCD提示腦梗死早期癇性發(fā)作的發(fā)生率和血管狹窄程度呈正相關(guān)，即表示早期癇性發(fā)作和腦部組織缺血缺氧有一定關(guān)系的病理學(xué)機(jī)理，為臨床資料證明病理學(xué)機(jī)理提高了參考。 5.急性腦血管病后首次癇性發(fā)作是否需要抗癲癇藥物治療，仍有爭議，反復(fù)發(fā)作時需要進(jìn)行藥物治療[48]。
[Abstract]:Objective:
After the onset of cerebrovascular disease, patients will leave serious limb dysfunction, and some patients will also have secondary epilepsy, causing serious physical and mental damage to patients and economic burden. The purpose of this study is to retrospectively analyze the clinical data of patients with early epileptic seizures of acute cerebrovascular disease (ACVD), so as to understand the pathogenesis and characteristics of ACVD, including sex, age, time, type, location, volume of hematoma and epileptic seizures, EEG and TC. D findings, treatment and prognosis.
Method:
A retrospective analysis of 2348 neurological inpatients and 56 of them with early epileptic seizures from December 2012 to January 2014 was carried out. Conduct statistical research.
Result:
1. A total of 2348 patients with acute cerebrovascular disease were studied, including 1341 males (57%) and 1007 females (43%). 2066 patients with cerebral infarction (88%), 235 patients with cerebral hemorrhage (10%), 47 patients with subarachnoid hemorrhage (2%). 56 patients with epileptic seizures, 26 males (46%) and 30 females (54%). There was no significant gender difference (P 0.05). The incidence of early epileptic seizures was 2%. The incidence of early epileptic seizures was 1% in cerebral infarction, 10% in cerebral hemorrhage and 12% in subarachnoid hemorrhage. Men were slightly lower than women, while men with subarachnoid hemorrhage epileptic seizures were significantly higher than women, the difference was statistically significant (P 0.05).
2. Among the patients with cerebral infarction, the incidence of early epileptic seizures was 0.4% in the age of 50 and under, and 1.4% in the age of 50, which was about three times that of the former. There was no statistically significant difference between the two groups (P 0.05). There was no significant difference between the two groups (P 0.05). This indicated that the incidence of cerebrovascular disease increased with the increase of population age, and the proportion of patients with early epileptic seizures increased with the increase of age.
3. Time of onset: There were 5 cases of cerebral vascular disease accompanied by epileptic seizures, 29 cases of epileptic seizures within 1 week and 22 cases of epileptic seizures between 1 week and 2 weeks.
4. Seizure types: The number of patients with partial seizures was the highest, accounting for 55 cases (about 98.2%), including 28 cases of simple partial seizures (50.0%), 16 cases of complex partial seizures (28.6%), 11 cases of partial secondary systemic seizures (about 19.6%) and only 1 case of comprehensive seizures (about 1.8%).
5. Location of onset: 18 cases of early epileptic seizures after cerebral infarction, cortical infarction accounted for 69% (18/26), subcortical infarction accounted for 31% (8/26), the difference was statistically significant (P 0.01). In 25 cases of early epileptic seizures after cerebral hemorrhage, 19 cases of cortex accounted for 76% (19/25), 6 cases of subcortex accounted for 24% (13/49). In short, the early epileptic seizures of cortical lesions accounted for 64%, subcortical lesions accounted for 36%, statistically significant differences were statistically significant.
6. The relationship between hematoma volume and epileptic seizures: 20% (5/25) of the patients with early epileptic seizures had more than 35 ml of hemorrhage, and 9.5% (20/210) had less than 35 ml of hemorrhage, the difference was significant (P 0.05).
7. EEG examination: 31 patients underwent electroencephalogram examination, 11 cases were abnormal, accounting for 36%, of which 3 cases were mild abnormal changes (27%), 5 cases were moderate abnormal with localized changes (46%) and 3 cases were severe abnormalities (27%). The rhythms of high amplitude slow wave, sharp slow complex wave, spike slow complex wave or explosive slow wave accounted for 43%, while those of other low amplitude fast wave caused by drugs accounted for 66%.
8. TCD examination: 21 patients with cerebral infarction were examined by TCD. The abnormal rate of blood flow velocity was 63% (92/147), and the abnormal rate was 32% (89/280) in the control group.
9. Treatment and prognosis: 45 cases of irregular oral antiepileptic drugs, including 40 cases of seizures once, 5 cases of seizures twice, temporary intravenous injection of diazepam, no recurrence. The remaining 11 cases received antiepileptic drugs, including 6 cases of carbamazepine (55%), 2 cases of phenytoin sodium (18%), 2 cases of sodium valproate (18%) and 1 case of carbamazepine combined with lumina (9%). One case received routine single dose therapy, and 1 cases progressed to status epilepticus.
Conclusion:
1. The incidence of early epileptic seizures in acute cerebrovascular diseases was 2%. The highest incidence of early epileptic seizures in subarachnoid hemorrhage was 11%. The incidence of cerebral hemorrhage was 10%. The incidence of cerebral infarction was the lowest, only 1%. In addition, the incidence of subarachnoid hemorrhage was higher in women than in men, while the incidence of epileptic seizures in subarachnoid hemorrhage was higher in men than in men. Female [44].
2. The incidence of early epileptic seizures is related to the incidence of acute cerebrovascular diseases, that is, when acute cerebrovascular diseases occur, the incidence of epileptic seizures will rapidly increase, and tend to be stable about l~2 weeks [45].
3. There are many types of epileptic seizures in the early stage, and partial seizures are the main type of seizures, while total seizures are the lowest [46].
4. TCD indicated that the incidence of early epileptic seizures was positively correlated with the degree of vascular stenosis, which indicated that there was a certain relationship between early epileptic seizures and cerebral ischemia and hypoxia, which could provide a reference for clinical data to prove the pathological mechanism.
5. Whether antiepileptic drugs are needed for the first epileptic seizure after acute cerebrovascular disease is still controversial. Drug therapy is needed for recurrent seizures [48].
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743;R742.1
本文編號：2240797
[Abstract]:Objective:
After the onset of cerebrovascular disease, patients will leave serious limb dysfunction, and some patients will also have secondary epilepsy, causing serious physical and mental damage to patients and economic burden. The purpose of this study is to retrospectively analyze the clinical data of patients with early epileptic seizures of acute cerebrovascular disease (ACVD), so as to understand the pathogenesis and characteristics of ACVD, including sex, age, time, type, location, volume of hematoma and epileptic seizures, EEG and TC. D findings, treatment and prognosis.
Method:
A retrospective analysis of 2348 neurological inpatients and 56 of them with early epileptic seizures from December 2012 to January 2014 was carried out. Conduct statistical research.
Result:
1. A total of 2348 patients with acute cerebrovascular disease were studied, including 1341 males (57%) and 1007 females (43%). 2066 patients with cerebral infarction (88%), 235 patients with cerebral hemorrhage (10%), 47 patients with subarachnoid hemorrhage (2%). 56 patients with epileptic seizures, 26 males (46%) and 30 females (54%). There was no significant gender difference (P 0.05). The incidence of early epileptic seizures was 2%. The incidence of early epileptic seizures was 1% in cerebral infarction, 10% in cerebral hemorrhage and 12% in subarachnoid hemorrhage. Men were slightly lower than women, while men with subarachnoid hemorrhage epileptic seizures were significantly higher than women, the difference was statistically significant (P 0.05).
2. Among the patients with cerebral infarction, the incidence of early epileptic seizures was 0.4% in the age of 50 and under, and 1.4% in the age of 50, which was about three times that of the former. There was no statistically significant difference between the two groups (P 0.05). There was no significant difference between the two groups (P 0.05). This indicated that the incidence of cerebrovascular disease increased with the increase of population age, and the proportion of patients with early epileptic seizures increased with the increase of age.
3. Time of onset: There were 5 cases of cerebral vascular disease accompanied by epileptic seizures, 29 cases of epileptic seizures within 1 week and 22 cases of epileptic seizures between 1 week and 2 weeks.
4. Seizure types: The number of patients with partial seizures was the highest, accounting for 55 cases (about 98.2%), including 28 cases of simple partial seizures (50.0%), 16 cases of complex partial seizures (28.6%), 11 cases of partial secondary systemic seizures (about 19.6%) and only 1 case of comprehensive seizures (about 1.8%).
5. Location of onset: 18 cases of early epileptic seizures after cerebral infarction, cortical infarction accounted for 69% (18/26), subcortical infarction accounted for 31% (8/26), the difference was statistically significant (P 0.01). In 25 cases of early epileptic seizures after cerebral hemorrhage, 19 cases of cortex accounted for 76% (19/25), 6 cases of subcortex accounted for 24% (13/49). In short, the early epileptic seizures of cortical lesions accounted for 64%, subcortical lesions accounted for 36%, statistically significant differences were statistically significant.
6. The relationship between hematoma volume and epileptic seizures: 20% (5/25) of the patients with early epileptic seizures had more than 35 ml of hemorrhage, and 9.5% (20/210) had less than 35 ml of hemorrhage, the difference was significant (P 0.05).
7. EEG examination: 31 patients underwent electroencephalogram examination, 11 cases were abnormal, accounting for 36%, of which 3 cases were mild abnormal changes (27%), 5 cases were moderate abnormal with localized changes (46%) and 3 cases were severe abnormalities (27%). The rhythms of high amplitude slow wave, sharp slow complex wave, spike slow complex wave or explosive slow wave accounted for 43%, while those of other low amplitude fast wave caused by drugs accounted for 66%.
8. TCD examination: 21 patients with cerebral infarction were examined by TCD. The abnormal rate of blood flow velocity was 63% (92/147), and the abnormal rate was 32% (89/280) in the control group.
9. Treatment and prognosis: 45 cases of irregular oral antiepileptic drugs, including 40 cases of seizures once, 5 cases of seizures twice, temporary intravenous injection of diazepam, no recurrence. The remaining 11 cases received antiepileptic drugs, including 6 cases of carbamazepine (55%), 2 cases of phenytoin sodium (18%), 2 cases of sodium valproate (18%) and 1 case of carbamazepine combined with lumina (9%). One case received routine single dose therapy, and 1 cases progressed to status epilepticus.
Conclusion:
1. The incidence of early epileptic seizures in acute cerebrovascular diseases was 2%. The highest incidence of early epileptic seizures in subarachnoid hemorrhage was 11%. The incidence of cerebral hemorrhage was 10%. The incidence of cerebral infarction was the lowest, only 1%. In addition, the incidence of subarachnoid hemorrhage was higher in women than in men, while the incidence of epileptic seizures in subarachnoid hemorrhage was higher in men than in men. Female [44].
2. The incidence of early epileptic seizures is related to the incidence of acute cerebrovascular diseases, that is, when acute cerebrovascular diseases occur, the incidence of epileptic seizures will rapidly increase, and tend to be stable about l~2 weeks [45].
3. There are many types of epileptic seizures in the early stage, and partial seizures are the main type of seizures, while total seizures are the lowest [46].
4. TCD indicated that the incidence of early epileptic seizures was positively correlated with the degree of vascular stenosis, which indicated that there was a certain relationship between early epileptic seizures and cerebral ischemia and hypoxia, which could provide a reference for clinical data to prove the pathological mechanism.
5. Whether antiepileptic drugs are needed for the first epileptic seizure after acute cerebrovascular disease is still controversial. Drug therapy is needed for recurrent seizures [48].
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743;R742.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 姚正鵬;袁良津;唐向陽;;腦卒中后癲癇118例的臨床分析[J];安徽醫(yī)藥;2010年10期
2 譚家香,李麗萍,李玲;腦卒中后癲癇186例臨床特點(diǎn)[J];廣東醫(yī)學(xué);2002年09期
3 曾楊濱;陸兵勛;;腦卒中繼發(fā)癲癇的臨床研究[J];廣東醫(yī)學(xué);2010年18期
4 楊新春;;急性腦血管病繼發(fā)癲癇的臨床特點(diǎn)分析[J];臨床醫(yī)學(xué);2013年01期
5 李桂花;宋永斌;楊俊;徐建春;張曉馨;徐江濤;;癲癇患者認(rèn)知功能與心理健康狀態(tài)的關(guān)系[J];中國健康心理學(xué)雜志;2011年06期
6 張媚;張臨洪;葉篤筠;;腦梗死后癲沲患者血清細(xì)胞因子水平的改變[J];臨床神經(jīng)病學(xué)雜志;2008年02期
7 馮艷蓉;田鴻福;;腦卒中后癲癇的臨床特征及其預(yù)后分析[J];吉林醫(yī)學(xué);2013年04期
8 顧寒英;宋永建;;急性腦血管病繼發(fā)癲vN的臨床研究[J];神經(jīng)病學(xué)與神經(jīng)康復(fù)學(xué)雜志;2009年03期
9 陳配桄;周定安;;腦卒中后繼發(fā)癲癇相關(guān)性臨床分析[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2012年03期
10 胡文立,劉艷偉,焦俊杰,陳天風(fēng);卒中后癇性發(fā)作及其再發(fā)因素的探討[J];中國實(shí)用內(nèi)科雜志;2001年01期
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